Santiago de Quiroga, president editor of leading Spanish pharmaceutical industry newspaper El Global and CEO of healthcare communications group WeCare-u, discusses the country’s health priorities, highlighting the upcoming Personalized Medicine Plan that the government will issue by the end of 2018 and predicts how regulators are going to find new ways of maintaining a reasonable incorporation of innovation in the foreseeable future.
Can you give us a brief overview of the healthcare challenges in Spain and the government action plan to tackle them?
From 2012 the Spanish Ministry of Health has been implementing cost-containment measures. Recently the European Commission asked Spain for an updated budget draft that contains more information on the basis that its 2018 draft budget plans posed risks to meeting EU debt and deficit reduction targets. The new budget plan that was sent to Brussels confirms that Spanish GDP will increase for eight consecutive years. However, this recovery remains unnoticed in terms of healthcare financing. The Ministry of Health will continue reducing the proportion of GDP dedicated to health until reaching 5.59 percent in 2021. If we put this in the context of the ever-growing need of financing innovation, it is surely going to be a challenge. On the one hand, we have the Senate which is currently drafting a non-binding report on personalized and precision medicines, with special focus on oncology, and on the other hand the Minister of Health announced that there is going to be a new personalized medicine plan which will be implemented and adapted to the 17 autonomous regions by the end of the year. The first National Cancer Plan was launched 15 years ago and the current situation is an opportunity to create a new plan on personalized medicine.
Can you elaborate on the Spanish health system’s performance, its effectiveness in treating people with life-threatening conditions and patients’ access to healthcare?
The Spanish National Health System guarantees universal coverage and no upfront expenditure from patients apart from paying a portion of prescription charges. In addition to this, state healthcare is free of charge to anyone living and working in Spain. A 2015 World Health Organisation survey showed that Spanish women outlive all other nationalities (living to 85.5 years) apart from the Japanese – so if you combine the costs and incorporation of innovation it is safe to say that it is one of the best in the world. In addition to oncology drugs, the government spends a great amount of public money on HIV and HCV treatment, given that Spain has a great prevalence and incidence of both diseases. It is going to be interesting to see how well the Ministry is able to finance innovation for such diseases while also reducing healthcare expenditures as a percentage of GDP.
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At the moment we have had a National Plan for infectious diseases, targeting HIV and HCV, for many years. We are now facing the problem of HCV virus reinfection among prisoners who had achieved virological suppression. To this purpose, we have great resources, very skilled infectious diseases experts who are very active and this is also the reason why Spain is one of the leading countries in HIV and VHC management and made significant progress in treating the virus and in identifying those most at risk. The HCV Plan is the most relevant in terms of investment and outcomes.
One of the most important challenges of the autonomous regions is the fact that money allocated in the forecasts never meets the expectation to meet the goal. I think it is essential to establish an agreement with all political parties to decide in which direction public healthcare should go – at the moment we have a 15 billion deficit. Especially the political party Ciudadanos, which is likely to become a key player in the political arena in the upcoming elections taking place in one year and a half, mentioned they would like to make healthcare a national priority.
In the pharmaceutical sphere, what would you highlight as major legislative update?
According to Javier Castrodeza, the Secretary General of Health said in the Senate, they are very active in finding ways to finance innovation. However, no one is really aware as to what models are being considered to this purpose – whether real world evidence, risk sharing or value-based pricing. This is the very challenge, i.e. to use one of these models to support innovation. At the moment everything is very much up in the air and the sustainability of the Spanish National Health System.
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Spain is Europe’s fifth and the world’s tenth largest pharmaceutical market. How would you evaluate the needs of the market in terms of key therapeutic areas and disease management?
Spain makes use of the Mediterranean diet and we are the second oldest country only after Japan. In terms of neurodegenerative diseases and oncology processes, both affected by aging, the government is on top of things. Disease management is a reality – Spain is going to shift from an acute disease market to a chronic one, we had 15,000 sales representatives in Spain. currently with a reduction of 50 percent. Pharmaceutical companies are now coming up with ways of approaching health authorities combining common interests and sustainability goals. I believe pharmaceutical companies have been carrying out a good job in the country and we are now faced with the challenge of a growing chronic market, aging and dependency.
What do you think is the future outlook of the pharmaceutical industry?
Regulators are going to find new ways of maintaining a reasonable incorporation of innovation and companies are going to overcome barriers about confidence. Furthermore, I see new financial models that will ultimately allow health authorities to achieve a reasonable market development, bearing in mind innovation such as in the field of immuno-0ncology and CAR-T that are going to reach Spain shortly. Healthcare is a priority in Spain and the economy is going to grow reasonably. Furthermore, health is going to be one of the most debated topics in the context of our upcoming elections.
