Outspoken, charismatic and dedicated General Manager of Pierre-Fabre Greece, Philippe Lambrinos, shares his insights on the company’s presence and performance in the challenging Greek market, how it’s manoeuvring issues of market access and clawbacks, as well as his overarching vision for Pierre-Fabre in Greece.
Mr. Lambrinos, you have spent 21 years of your career as the General Manger of Pierre Fabre Greece. How has Pierre Fabre’s operations grown in this time span?
“The clawback measure is the most inefficient and unjust way for funding a flailing healthcare system.”
The company was created on the 11th of January 1996, which was the exact date when we officially received the VAT tax number. We then began commercializing our first product, Navelbine IV, in November of the same year, with sales predominantly directed to hospitals. Thereafter, in 2003, we launched Navelbine Oral; in 2006, we launched Busilvex; and in 2008, we launched all oncology products, thus expanding our portfolio. Moreover, there was also a third business unit in Greece during that time called Pharma-Fabre, which had been formed through a joint venture. However, in 2008, this business unit demerged and we consequently acquired most of their oncology and mature products, while Pierre-Fabre dermo-cosmetics acquired their oral care products. From then on, we continued to promote all these products under the Pierre Fabre name in Greece. Today, the key growth drivers are oncology and iron products, which constitutes around 80 percent of the sales. The workforce has remained stable throughout and approximately 13 medical representatives and staff were inherited in the demerger, as well as a much larger physical office space.
How is the global portfolio of Pierre-Fabre reflected here in Greece?
As an affiliate, ultimately the decisions are made at the headquarter level and trickle down in Greece. The strategic direction is decided for us at the corporate level, and they are responsible for submitting the proposal to the European authorities. Essentially a central file is submitted but approval from all the other EU members are achieved at different times. Currently, we have a partnership with an American company, Array, for two immunotherapy products, namely, Binimetinib and Encorafenib, both of which are treatments for melanoma. These two products are awaiting approval within 2017 and are expected to be launched in late 2018.
For the products that have driven sales and growth, what has been the reason for their success in the Greek market?
Oncology and iron products constitute 80 percent of sales and there are three main products driving this growth: Navelbine Oral, a drug for lung and breast cancers which has patent protection until 2022; Javlor, which has a very niche market in offering second-line treatment for bladder cancer; and Busilvex, which is another niche market for bone marrow transplantation. We essentially have a portfolio that caters to targeted medical needs. Thus, our success has been largely driven by the fact that our products are cytostatics, clear-cut and fulfill specific medical needs that enabled them to endure market conditions with longevity. It is a combination of the nature of cytostatics having robust results, as well as our ability as a company to be proactive and reactive with market conditions.
Furthermore, we have also prolifically developed the metronomic administration of Navelbin Oral, which is a unique way of administering cystostics which can only be done with oral drug. The existence of an oral alternative ultimately saves patients a trip to the hospital where they could be exposed to demoralizing conditions. Especially when considering the geographic composition of Greece with its mainly islands that isolates many patients, an oral product is extremely beneficial because it eliminates the necessity for travel and the treatment could be self-administered by the patients even when the physicians are based elsewhere.
In regards to launching new products, market access discussions are under scrutiny given that they are currently geared towards becoming more expensive and time-consuming. How are current conditions impacting Pierre-Fabre’s operations?
As it stands today, Greece has one of the worst bureaucracies in Europe. Unfortunately, delays are commonplace. For instance, if I were to submit a local file today, it would only be fully processed in three years. If I were to submit a central file, despite having the directives of the European Union, a realistic expectation for it to be processed is within 1.5 to two years. Exacerbating an inefficient bureaucratic process is the fact that there are two approval channels – one of which is for the scientific approval and the other is for the price approval. To wait to have 14 other countries in Europe approve a product before reaching Greece is detrimental. Not only does it reduce the life span of the product in the market, but it also deprives patients of critical treatments right at the onset of when the treatment could have been made available for them.
Navigating through the current market conditions have been rather frustrating. I am cognizant of the fact that representatives from SFEE (Hellenic Association of Pharmaceutical Companies) are speaking with relevant authorities to mitigate the dissatisfaction across the industry. Though the 14-country requirement has yet to become an official law, we are starting to feel the drastic impact that it will bring upon our businesses because profits are sure to be drastically reduced. As a concrete example, it will be completely impossible for the melanoma products to be launched on the expected date on 2018 if the law were to pass and the requirements finalized. It will require another two to three years, which means a shorter shelf life in the market.
Another area of contention is clawbacks and rebates. How has Pierre Fabre been maneuvering through these challenges and how can it contribute to creating a sustainable healthcare system?
The clawback measure is the most inefficient and unjust way for funding a flailing healthcare system. The budget seems to be arbitrarily chosen and the fact that it keeps being lowered year per year is out of touch with reality. In every civilized country, the trend has been for healthcare and pharmaceutical expenditure to increase every year. Contradictorily, for Greece, at the onset of the crisis, budget was set at 2.2 billion EUR, which then decreased to 2 billion EUR for two years, and by 2016, it was set at 1.945 billion EUR. This regressing trend is clearly not sustainable, especially given the fact that new products in the market are continually becoming more expensive.
Firstly, the burden of the cost difference will inevitably need to fall on someone’s shoulders and this burden has been predominantly carried by the pharmaceutical industry. Currently as it stands, one out of four medicines is being paid for by the health industry. Moreover, another group directly hit by the burden are the patients themselves. They also cover the cost difference through what is referred to as a social security price. Thus, it is apparent that insecurity is prevalent amongst all players in the healthcare landscape.
What is the overarching vision for Pierre-Fabre in Greece for the upcoming years?
First of all, I think finding ways to invest in the healthy part of the system is imperative, which for the pharma sector constitutes the OTC segment. Though there are issues regarding the level of reimbursed products across the industry, this income could be compensated through leveraging the lack of restrictions in the OTC market. The dynamic of the playing field then becomes about survival and on how much of the profits are recuperated through the OTC segment. This sentiment resonates for Pierre-Fabre as a strategy to mitigate the crisis to invest in sub-segments in the market without price controls and less volatile supply and demand that requires different sets of expertise. This is a philosophy we hope to instill in the years moving forward to pave the way for sustainable success in the future.
Having led the company for over 20 years, how would you like the legacy of your leadership to be remembered?
I would like to leave behind a company that can thrive and withstand challenging economic conditions. I believe myself to be a leader who carefully evaluated opportunities and used all available resources to try to overcome the crisis. We cannot follow the same patterns over and over again, especially given the fact that we are in a shrinking and restrictive market that imposes harsh measures with a high level of uncertainty. It is imperative to find alternatives in the same market in niche areas where growth is still possible.