Mario Sturion, the recently appointed general manager of Janssen Mexico, assesses the specific challenges and opportunities of the Mexican health system and explains how a customized market access approach has been critical to Janssen’s success in a country noteworthy for the complexity of its public health system.
You took over the helm of the Mexican affiliate in December 2015, after having headed Janssen’s footprint in the regional cluster that gathers Colombia, Peru, and Ecuador, and Puerto Rico. After almost one year at the head of the Mexican affiliate, what is your first assessment of this new chapter in your career?
“Besides being the second largest market in Latin America, the Mexican health eco-system is unique in many ways, in areas like innovation access, distribution and the overall structure of the public health system”
These first eleven months in Mexico have already proven to be a very enriching learning experience. Although Mexico is a Latin American market, a region in which I have substantial experience, I am fully aware it doesn’t mean solutions that I have successfully implemented in other Latin American countries can be exactly replicated in Mexico. Besides being the second largest market in Latin America, the Mexican health eco-system is unique in many ways, in areas like innovation access, distribution and the overall structure of the public health system. Understanding these dynamics and the opportunities and challenges they represent has been one of my priorities since I took over.
What key specificities of the Mexican eco-system have drawn your attention so far?
The Mexican eco-system has been continuously evolving and improving in many aspects over the past decade. One of the most notable drivers for change has been Cofepris’ rising international recognition and the upgraded regulatory framework Mexico’s regulatory agency has been tirelessly implementing over the past years.
Looking at the public sector, the implementation and steady enlargement of Seguro Popular has been positively impacting the healthcare access level in the country, by finally providing basic medical coverage to the most unprivileged part of the Mexican population. Nevertheless, the overall size of the Mexican public health sector and the multiple institutions it encompasses make it ever more challenging for the Mexican government to coordinate its action. In this regard, OECD data clearly demonstrates that substantial discrepancies persist across the country, depending on the geographical area. Finally, we see that the Mexican government is currently implementing ambitious reforms to foster the exchange of medical services between different social security institutions, which is as an interesting first step toward universal healthcare.
Looking at the private market, notably, we see big pharmacy chains are taking control of the retail sector, which is experiencing an on-going consolidation. An important change in the private market was the introduction of added value services such as the development of physicians’ offices adjacent to pharmacies, which offer convenience with affordable prices, making them particularly popular with the low and middle-classes for common or acute illnesses. According to recent Funsalud research, 60,000 doctors now provide medical consultations and issue prescriptions under this model.
How are you tailoring Janssen’s product offering to the specific needs of the Mexican population?
The Mexican market stands as one of the main emerging markets in the world, which means important growth opportunities for innovative companies like Janssen. Over the next decade, several sources indicate that pharmaceutical demand in Mexico will be driven by changing demographics (an aging population), a growing middle class and an epidemiological transition from communicable diseases to chronic degenerative diseases.
In Mexico, Janssen provides patients and the healthcare community with an important number of highly-innovative oncology treatments, such as ibrutinib, for chronic lymphocytic leukemia and mantle cell lymphoma; abiraterone acetate for metastatic prostate cancer; daratumumab for the treatment of multiple myeloma and mantle cell lymphoma; and bendamustine, to treat indolent non-Hodgkin’s lymphoma.
The metabolism area is also particularly crucial in Mexico, where there are 11.4 million patients with diabetes and only 25 percent of them are under control. In this therapeutic area, we notably offer canagliflozin, one of a new therapeutic class of SGLT2 inhibitors that operate in the kidney to control glucose levels in the patients’ blood streams.
In the immunology field, we boast one of the most complete biotech portfolios of the pharmaceutical industry in Mexico, with infliximab and golimumab for the treatment of autoimmune diseases such as rheumatic diseases and inflammatory bowel disease and ustekinumab for psoriasis.
Despite the epidemiological transition that the country is currently experiencing, infectious diseases still remain a priority for the Mexican government. In this field, we offer innovative treatments to HIV patients such as darunavir, for the initial and advanced stage of the virus and etravirine, for patients previously treated with other ARVs. Finally, simeprevir, our innovative treatment for hepatitis C, has proven to cure the disease in 97 percent of cases, when combined with sofosbuvir.
How would you rate your relationship with the country’s main regulatory and public stakeholders, such as COFEPRIS and the public social security institutions?
Our relationship has been extremely positive. The quality of the relationship and partnership work with Mexican stakeholders such as COFEPRIS is critical to make available our innovative portfolio to Mexican patients.
COFEPRIS continues improving regulatory processes and usually invites companies, through pharmaceutical associations and the national chamber, to participate in the review and development of initiatives; Janssen is an active participant, driving the patients benefit as COFEPRIS. To ensure the continuity of successful initiatives to minimize sanitary risks, this year COFEPRIS Commissioner announced a program based on 5 guiding principles and 15 specific actions. Janssen welcomed it; this new program underscores Mexico’s commitment to ensuring an efficient and high-quality regulatory environment.
We are also committed to participate in the update and development of COFEPRIS capabilities thru our international experts’ participation in ad-hoc forums organized by Associations and COFEPRIS.
Regarding the Public Social Security institutions, Janssen Mexico has a formidable team with extensive knowledge, passion for patients and experience with the Mexican health system, which is composed of several sub-systems. This team and our experts that work on a daily basis with all these institutions are the real strength of our market access capacity. We know the impact on patients of our innovative therapies. Our challenge is to work in partnership with the Public sector to make this happen.
Rather than being exclusively focused on our products’ specifics or performance, we need to precisely know Mexican public health payers’ objectives and challenges, in order to better align our access solutions with their needs and prioritize certain aspects of our portfolio.
We cannot content ourselves with simply offering what our industry has coined as “differentiated access models.” Any given access model, as innovative or financially advantageous as it may be, cannot be considered a satisfactory solution if it isn’t truly tailored to the needs of the public partners you engage with. If we don’t concentrate our efforts on identifying the real expectations of Mexico’s customers and healthcare institutions, a market access proposal that we may consider utterly innovative or cost saving could ultimately show itself to be inadequate. Co-creating solutions with public/private payers is the appropriate approach to expand access to all patients in need.
This alignment effort indisputably is easier said than done, and clearly requires a long-term commitment of Janssen to the Mexican healthcare system.
As one of the leading pharma companies in Mexico, what should be some of the priorities of the industry to further increase health outcomes in the country?
Janssen is strongly supporting AMIIF [the association gathering the pharmaceutical innovators implanted in the country, e.d.] in conducting scientific studies that clearly demonstrate how investing in healthcare innovation positively impacts Mexico’s productivity, in addition to generating positive health outcomes for our patients. Mexico will never become one of the most competitive economies in the world without a healthy, productive workforce. While Mexico looks at consolidating its positioning as one of the most attractive hubs in the world for advanced manufacturing, the increasing burden of chronic, non-communicable diseases and dramatic epidemics like diabetes and obesity could compromise the country’s great potential.
In the meantime, improving health outcomes should not only sit on the shoulders of the government, especially in the context of the recently released health budget cuts. For example, in Mexico, the private insurance system remains particularly underdeveloped, both in terms of population coverage (six percent of the population) but also with regards to the health coverage/price ratio. As the country’s middle-class continues to grow, more and more Mexican households could be keen to slightly increase their health spending in order to access better medical services.
In this regard, our industry in general and Janssen in particular has a role to play in developing this part of the healthcare value chain, by bringing our international experience and best practices to these companies. At the end of day, increasing private insurance coverage could unburden the public sector and contribute to better health outcomes for the part of the Mexican population that cannot afford private insurance.
In which specific areas do you want to establish Janssen Mexico as “best-in-class” in the global eco-system of the company?
Considering the challenges we face in the country and the complexity of Mexico’s public system, Janssen Mexico can become a global reference and a frontrunner in terms of market access. For example, we are currently working on several pilot projects in which we design different access models for a single product – and we replicate a similar approach for all the different social security institutions of the country. In this regard, Janssen Mexico can lead the way in terms of market access customization and become a source of inspiration for other affiliates around the world.
“Considering the challenges we face in the country and the complexity of Mexico’s public system, Janssen Mexico can become a global reference and a frontrunner in terms of market access.”
The second aspect relates to diabetes. We are already conducting some groundbreaking clinical trials in this field in Mexico, and our affiliate could become a major knowledge hub for the group. In the meantime, we are working to fully leverage the therapeutic solutions that the Johnson & Johnson group can offer, adopting an approach that goes beyond the pill and embraces intervention and monitoring solutions.
You have had a successful career at Janssen over the last 20 years, starting as a sales trainee to become general manager in Mexico, one of the most strategic markets for the group. What has been your personal recipe for success that has helped you to climb the ladder?
I would probably say adaptability and resilience. I had substantial exposure to many emerging markets, essentially in Latin America, where markets vary significantly from one country to another. A shared factor in these markets may however be their unpredictability: I had to face unexpected situations and as general manager, had to find appropriate solutions.
When operating in these markets, it is also particularly important to remain loyal to your values. In many ways, a leader can be tempted to flex some of them to reach short-term objectives or benefits. Never do that. Live your values every day. Putting the patient first is one of my key values.
“The quality of your teams often stands as the critical parameter that determines whether you will ultimately be able to overcome challenges or not.”
Finally, talent management has been a crucial success factor during my career. The quality of your teams often stands as the critical parameter that determines whether you will ultimately be able to overcome challenges or not. Prioritize and invest time in building the best team.
What explains your loyalty to Janssen?
First and foremost, at Janssen, we have a set of values we truly live by and that are perfectly aligned with my own convictions. These values indicate that our first responsibility goes to our patients, followed by our employees and the communities where we live. By getting that right, our shareholders should also receive a fair return.
Janssen’s fundamental values are so strong that they inevitably attract and retain people that genuinely share the same drivers and objectives. I am lucky to work in an environment where all employees share the same values as I do, and whatever the country I work in, I can expect all my collaborators to share the same overarching priorities.
Furthermore, I have been working at Janssen for twenty years, but I feel like I joined the company yesterday. As part of the Johnson & Johnson enterprise, Janssen offers an almost unlimited number of development opportunities, through a great variety of different positions, experiences and our global footprint. To be honest, I often feel more refreshed than some of my peers that are changing companies every three years.
Our report is called “Stepping up the pace”. What does this title mean to you?
To me, it means being able to increase the access of the Mexican population to innovative, life-changing treatments. I know the impact that these therapies can represent to patients and their relatives, and if we manage to expand it to a broader patient population in need, I have achieved my mission.