Novo Nordisk Turkey has taken a degree of leadership by working to facilitate and encourage cooperation and collaboration between different stakeholders in the diabetes management ecosystem. For general manager Şebnem Avşar Tuna, developing stronger lines of communication with regulators and payers is the top priority going forward.


Following your first interview with PharmaBoardroom on behalf of Novo Nordisk Turkey in 2012, what have been the key achievements of the affiliate since then?

Over the last three years our business has continued to grow at a double-digit rate and we have achieved top line sales growth as well as improvements in operational efficiency across the organization. Although we were having challenges associated with pricing and exchange rate issues we were able to ‘Change Diabetes’ with our innovative products on the Turkish market as a treatment option for the more than ten million diabetic patients living in Turkey. The organization is still growing in people and talent to help meet strong and growing demand, and we are very proud to be able to help meet the needs of diabetic patients in Turkey.

As before, our business is still strongly concentrated in the diabetes area, with 85 percent of our turnover coming from our portfolio of innovative diabetes products. The remaining 15 percent is consists of our biopharmaceuticals portfolio, meaning our hemophilia and hormone product lines together.

What steps have you taken to address currently unmet medical needs of diabetes patients?

In 2013, we partnered with Ministry of Labor and Social Security and the Social Security Institution (SGK) to bring together 300 executives from Turkey for an “International Diabetes Leadership Forum”, which featured a keynote speech from former UN Secretary General Kofi Annan and a special address via teleconference from former US President Bill Clinton. This forum brought together executives from the industry, payers, policy makers, healthcare professionals, patient organizations, and representatives from key international diabetes medical associations, from a wide range of countries across the region to discuss the current unmet needs of patients, potential strategies for addressing these needs, as well as defining the responsibilities of different stakeholders within the system.

The results of these discussions were published in a “Istanbul Diabetes Roadmap”, under which each stakeholder agreed to take on certain responsibilities to improve diabetes treatment here in Turkey, such as the Ministry of Health agreeing to train physicians in primary care, and the social security institution (SGK) committing to increase coverage for diabetes related health expenses such as eye care and food for patients, as well as coverage in the early and preventative phases.

At the regional level, this event also had strong impacts on neighboring countries. For example, after this meeting Iran updated the reimbursement status of the most innovative diabetes products on the Iranian market, and now diabetes products are reimbursed to a very high standard in Iran. In Pakistan, insulin is now being distributed for free to children and adolescents under the age of 18 in certain provinces, and in Jordan 15 diabetes healthcare units were established by the Jordanian Ministry of Health.

We are very pleased with the positive results of this forum, and Novo Nordisk will continue to exercise a degree of leadership in the diabetes ecosystem by organizing awareness initiatives, and facilitating collaboration. Diabetes is a key healthcare issue worldwide, with nearly ten million diabetic patients in Turkey, and to properly address a healthcare issue of this magnitude all of the relevant stakeholders must cooperate to develop coordinated healthcare solutions for this large patient population. Novo Nordisk’s commitment in this respect is to secure the resources for R&D so we can bring more value and innovation to patients and payers in the future, as well as the healthcare economics data to justify the cost of these treatments, which can prevent major medical complications in the future.

In many countries Novo Nordisk seeks to facilitate patient access to medicines by providing non-innovative generic insulin as well; how has this initiative been implemented in Turkey? 

As the universal healthcare insurance provides a very strong foundation for healthcare treatment in general, and in diabetes, we are able to provide modern insulins for the treatment to people with diabetes. Established insulin products are fully reimbursed in Turkey, so all diabetes patients have access to good quality and effective medicine. Globally, we continue to develop further medicines and treatments which are highly innovative and in Turkey we work hard and negotiate with the government institutes to get marketing approvals and reimbursement for our highly innovative products so that the patients nation-wide have access to the products that allow them to effectively treat their condition.

How will Novo Nordisk Turkey’s portfolio evolve over the next five years?

At present, our portfolio is made up of highly innovative products and we are constantly developing new and improved innovative medicines. In Turkey, we struggle with the launch of new products but we work hard to get them in Turkey at the same time with other European countries.

Today, market access is a bit more challenging in general going forward. The SGK has made it very clear that increased costs in healthcare budget require cost containment measures for existing products as well as the innovative new drugs. This of course is a barrier in the industry to bring new innovative products to Turkey. For patients to have access to these new innovative products, it is essential that the different stakeholders in the public sector and industry communicate openly, seek to understand each other, and continue to prioritize patient wellbeing to ensure that fair and effective solutions can be found.

As Novo Nordisk Turkey, we are currently adapting our business model to better fit the needs of the public healthcare sector and the SGK, so that we are able to collaborate with them more effectively as a partner for the treatment of diabetes. The key aspect of this type of collaboration is effective communication, and from our side we are working to improve our ability to communicate and explain the incremental-value of innovation and our innovative products over existing treatments to the authorities and the public.

Globally, Novo Nordisk often discusses innovative products in the context of “best patient outcomes”; is this concept well understood in your discussions with public sector stakeholders?

Physicians are very well aware of this idea, and Novo Nordisk’s presence in global medical journals and publications, as well as our scientific education initiatives here in Turkey, make it clear that our ultimate goal is to ensure that all diabetes patients have the best possible outcome. Regulators understand that more innovative products can achieve better results, and help patients manage their condition more effectively. However, we are still seeking to improve our ability, and the ability of the healthcare professionals that we work with, to communicate the significance and scale of this incremental-benefit to regulator, particularly the impacts they can have on patient health and rates of diabetes-related complications in the long-run.

In 2011, Novo Nordisk came to a “unique compromise” with the Turkish authorities, and now the SGK is inviting companies to submit proposals for “alternative payment models.” How can your 2011 solution act as a model for these new proposals under development?

We have the ambition to be pioneer in this role as well, and I am proud to say that Novo Nordisk is taking a position of leadership in this pricing reform process.

For Turkey specifically, what is your vision for Novo Nordisk, and what are your priorities for the next five years? 

Novo Nordisk is an innovative company, our growth is driven by innovative products, and our commitment at the global level is to develop innovative medical solutions for diabetes patients to allow them to live a healthy life. As such, people are our most valuable asset, ranging from Novo Nordisk employees to stakeholders across the healthcare ecosystem and of course patients, and these people and our relationships with them are our highest investment priority.

As an executive of Novo Nordisk, my most important responsibility is to continue to communicate with regulators and public servants, to demonstrate our commitment to Turkey as a partner and supporter of the healthcare system, and to of course help find solutions that allow us to bring innovative products to patients in Turkey, while achieving a sustainable financial outcome. For Novo Nordisk, Turkey is still a growing market and we do our best to find ways to build upon our position in the Turkish diabetes environment through partnerships and collaborative projects, and to establish and improve patient access to our most innovative products.

Click here to read more articles and interviews from Turkey, and to download the latest free report on the country.