Diabetes affects an estimated 6 million Brazilians, a figure which is expected to double by 2025, in line with many other developing nations. Like many other “rich-country” diseases, there is a tendency for its sudden prevalence to result in less-than-adequate treatment profiles. What have you observed here in Brazil?
The situation of diabetes in Brazil is similar to that of my home country, Argentina, where awareness is really low. Individuals with diabetes often simply don’t know they have it, and the diagnosis rates reflect this unfortunate situation. Half of the 50% of diabetics who are diagnosed receive some kind of treatment and only 25% achieve their targets. Therefore, Novo Nordisk’s concern is how to improve diabetes awareness and how to increase the diagnosis rate as well as the coverage of insulin at the early stages of type 2 diabetes, where many patients experience an average delay of 8 years of oral treatment before going to insulin. They do not fall within the recommended HbA1c target of the Brazilian Society of Diabetes, that is, below 7%. The Brazilian government has been working hard to improve diabetes care in Brazil; however, we still have a long way to go. For example, the MOH provides patients with human insulin in vials despite the fact that nowadays more innovative treatments are available, like modern insulin in ready-to-use devices.
Earlier this year, Dilma Rousseff eliminated the co-pay for diabetes and hypertension medications through Farmácia Popular (popular pharmacy), in the “Saúde Não Tem Preço” (health is priceless) program. What was the effect of this decision on diabetes?
We believe the program will improve access to medication, which means better standards of care. However, from an economical perspective, the greatest impact of this decision fell on the pharmaceutical industry since we are the ones who had increased our discounts to make it possible for patients to receive the medication for free. Ironically, in fact, the government has not discussed whether, at the end, this kind of project increases the total amount of money spent on diabetes treatment. For example, from the exclusive point of view of the medication costs, in the case of insulin, Novo Nordisk supplies 15 million vials per year to the MOH at very low prices. Notwithstanding, when we provide patients with human insulin vials through the Farmácia Popular program, the MOH spends more money than when they buy through the Federal tender.
You came here at the beginning of 2010. What was your mission?
Our mission at Novo Nordisk is always the same: “Changing Diabetes”, of course. We offer the broadest diabetes product portfolio within the diabetes market. The major issue is how to provide this treatment to the general population in order to improve their quality of life. We work with diabetes associations and patients associations, but working with the government is still a big challenge in Brazil.
Novo Nordisk acquired Biobras in 2002 and since then has invested hundreds of millions of dollars in the Montes Claros facilities, the biggest production site for insulin in Latin America. What does Brazil represent in the overall corporate portfolio?
In the Novo Nordisk world, Brazil is important because of its 200 million inhabitants, of which 7% of adults have diabetes – that means 11 million people who need a better quality of life. The financial and operating revenue impact in Brazil is very low. Argentina’s sales and volume of insulin are much greater, in spite of being a country with only 40 million people; something is surely wrong.
Almost 70% of the market volume is basal insulin, with only 30% represented by the modern insulin, so the next challenge is how to switch patients from human to modern insulin, and to new devices. Last year, Novo Nordisk has developed a market access department, to coordinate activities and to improve treatments aiming to reach our targets. As a result, last year we grew 35% with modern insulin.
The big challenge is to hire people in Brazil with the right vision and values in line with our Novo Nordisk Way. We have tried to hire a sales director for six months, and now we are searching for similar positions for financial and marketing sectors. We may end up with a General Manager from Argentina, a Finance Director from Zurich – at some point we will need someone from Brazil!
Overall, there is a good opportunity, and Novo Nordisk is committed to continue working closely with associations and government to change the situation. As Brazilians say, “Devagar se vai ao longe” (fair and softly goes far).