At the company’s 40th anniversary, Biogen’s Canadian head Marina Vasiliou gives an insight into her priorities as new managing director, her approach to building relationships with all stakeholders in the healthcare system to ensure access to Biogen’s innovative treatments, and explains how the portfolio of the neuroscience leader is perfectly fit for the Canadian healthcare needs.
Marina, following a long career at Merck, you joined Biogen in November 2017. What were your first impressions of Canada?
I was very excited to join the Canadian operations. After having worked in the USA, the Middle East and Western Europe, and having a Greek, French background in my family, being in such a diverse country as Canada is a great opportunity. Indeed, I think that Canada’s biggest strengths are its diversity and openness—whether that is in health sciences or the culture itself—two of the first things that were very evident upon my arrival. This unparalleled diversity means strong Canadian talent and this is the kind of talent we want to attract in Biogen.
What are your main priorities for your tenure?
I am responsible for increasing our current footprint in Canada through increased investment into R&D, working to ensure that patients can get access to our medicines, delivering on our business objectives and enhancing our reputation. Our focus will be on building the best team possible and being flawless on the implementation of our strategy. In Biogen, a strong team is important as we strive to achieve our mission as pioneers and leaders in neuroscience. It is a very exciting time for Biogen in Canada.
Finally, we want to show to Canadian governments, healthcare professionals and patients, that Biogen is here as an innovative leader dedicated to working with them to find solutions in this complex system. One of the key debates these days evolves around easy access for patients in the fields of neuroscience and rare disease. Biogen is committed to work with all Canadian stakeholders to be part of the solution.
Having spent the last few years working in the US, what are the main similarities and differences you have noticed between Canada and its Southern neighbor?
In both countries, we find very complex health science environments with public and private payers. Naturally, there are some distinctions. Canada is very unique as the country places great emphasis on equality of access when it comes to health-related matters. The system overall is quite complex and perhaps even more decentralized compared to the US, especially as it relates to decision-making at the federal and provincial levels. Culturally speaking, Canadians can be very direct but their politeness is a great strength.
Biogen has a very different value proposition within the healthcare space. In your view, and coming from a different company, what differentiates Biogen from other peers?
Joining Biogen approximately six months ago has been one of the best decisions of my life—both personally and professionally—. Undeniably, Biogen offers a very unique value proposition, as we are the only company that is 100 percent invested in neuroscience.
We have seen big pharma players investing in the field but given that neuroscience is a very difficult turf, it is challenging to be a relevant and persistent player if all of your efforts are not devoted to this particular field. Therefore, I can proudly say that Biogen is the undisputed leader in neuroscience. We are very excited about our pipeline and the future that lies ahead of us. We are ready to take our history in neuroscience and pair it with great transformation in order to be flawless executers in bringing molecules to market and to patients. In Canada we have a broad portfolio and we are leaders in Multiple Sclerosis (MS) but our introduction of the first treatment of Spinal Muscular Atrophy (SMA) and what lies ahead in our pipeline are rapidly transforming us to a leader in neuroscience.
Although approved by Health Canada and recommended for certain patient groups by CADTH (Canadian Agency for Drugs and Technologies in Health), Spinraza® has not yet at the time of our interview been included on the reimbursement list by any province. How do you advocate with stakeholders to ensure breakthrough innovations like Spinraza® ultimately reach patients in Canada?
Spinal Muscular Atrophy (SMA) is a rare and debilitating disease and in its gravest form infants do not reach their second birthday. We are very proud to have led the largest clinical development program in this difficult disease and last week, on February 23rd, 2018 Biogen published CHERISH: Phase 3 Study Results in Individuals with Later-Onset SMA in the New England Journal of Medicine. The data from all our studies clearly demonstrate significant and clinically meaningful improvement in children with SMA of all types compared to untreated children and support not only efficacy but also safety of Spinraza®. So far, 17 countries have recognized the results and accordingly, in those 17 countries we were able to work with payers to find reimbursement solutions for all the patients that can benefit from Spinraza®. I am a very optimistic person and I believe the Canadian provinces have a great opportunity to review the available evidence and acknowledge the value Spinraza® can bring forward for all the children and their families that need it.
Ultimately, I believe that all stakeholders in Canada have the same goal: providing access to all patients affected with SMA, particularly because they have no other hope or alternative treatment.
Very recently, the pCPA (pan-Canadian Pharmaceutical Alliance) has announced the commencement of price negotiations, appreciating that we are facing a critical unmet medical need in Canada. We take this first step as a positive sign.
Pricing is always a sensitive topic, especially for rare disease drugs. How is Biogen communicating the value of its products—and potential for risk-based or value-based pricing models?
The most important thing is to develop and make accessible breakthrough therapies that provide significant value. We are not speaking about ‘me too’ therapies but on the contrary areas of real innovation in difficult neurological conditions. In order to be able to invest in this kind of innovation, you have to collaborate with the entire continuum of healthcare stakeholders, including payers. Biogen as a company wants to work towards outcome-based pricing models across our entire portfolio.
Biogen focuses on neurology and immunology, with most of its global revenue derived from its MS activity. What are some of the particularities of MS in Canada?
Our portfolio is as such a very Canadian portfolio, as both MS and Alzheimer’s are very prevalent among Canadian citizens. The Canadian government constituted mental health to be a priority within Budget 2017, committing CAD five billion (USD 3.85 billion) over ten years to support mental health initiatives.
For MS specifically, the prevalence in Canada is very high and it can affect people from a very young age. It is a debilitating disease and we are very proud to have contributed in the fight against it, having been a leader in this field for decades.
However, whereas the prevalence of MS is high, early diagnosis often falls short. Canada is in a particularly difficult situation: it has the highest prevalence but certainly not the highest diagnosis and/or treatment rate—a mismatch that we in Canada need to improve on rapidly, especially when it comes to centralized MS care recommendations; there are currently no such in place, resulting in inaction. These are complex issues, which need to be addressed by all relevant stakeholders as soon as possible.
What are you excited to bring to Canada next?
We are very excited about three major things. Firstly, we want to ensure to bring Spinraza® to every patient in Canada who is in dire need of it. I am confident that we will be able to reach solutions with all stakeholders involved because it caters to a critical unmet need. It is heartbreaking to see mothers whose children are weeks away from a tracheotomy, knowing there is a treatment that can avoid this. Therefore, our immediate focus is bringing Spinraza® to Canadian patients.
Secondly, we have MS treatments with diverse risk and benefit profiles. As a result of increased business development activities, we would be able to bring MS molecules to market quickly.
Finally, our bigger mid-term goal is to help Canada prepare for solutions for Alzheimer’s patients. We are currently in Phase 3 trials for our Alzheimer’s drug aducanumab. As of yet we cannot share any results but we believe that all our research will bring to light great solutions for patients, in Canada and around the world.
As a biotechnology and highly innovative company, R&D is essential to Biogen and Canada has excellent R&D potential. Besides conducting part of the Spinraza® studies here, how do you plan to further leverage on it?
I think Canada has a unique value proposition in the R&D landscape. Geographically, it is located right next to the US, the biggest pharmaceutical market in the world and of course, one of the most innovative countries globally. On the other side, Canada is often clustered with Europe in corporate structures, due to health system similarities. This means that Canada can become influential in terms of innovation, both in the US and Europe.
Within our own organization, we are in the process of establishing a team dedicated to developing innovative solutions around the patient pathway, going beyond our products, considering the holistic value proposition we can bring to patients—including elements like hospital administration, or the support network for rare diseases—. We are currently looking for the right partners to make sure that Canada becomes a center of excellence in innovation.
Are there different ways of thinking ‘pharma’ across the world?
There is a common major issue in all health care systems across the world: access to innovative treatments. What keeps us up at night is the question of how do we best ensure access for very innovative, breakthrough treatments—this is no different in the US, France, Canada or the Middle East—. The overarching theme remains the provision of access, whether you operate in wealthy or poor countries.
An interesting example is Greece, which is in a severe economic crisis. Yet, the government in collaboration with Biogen has been able to finance reimbursement for Spinraza®, a great achievement for Greek patients.
If there is one thing a global career has taught me is that the primary subjects in each country are very common, but stakeholders and their diversity is very different from country to country. Thus, adaptability is key. You need to embrace each system, understand the interest of all stakeholders involved and build true partnerships with them to be successful and adaptability certainly gives you the edge in those conversations. Gaining experience in different countries majorly contributes to being an open-minded and adaptable person, and is especially a great skill for the Canadian culture!
