Irma Veberic, general manager of Roche Hungary, gives her insights on the key issues being faced by the Hungarian healthcare system and the company’s role as a partner in improving health outcomes and raising life expectancy in the country. Veberic goes on to highlight the affiliate’s strong contribution to Hungary through investments in clinical trials and a new pharmacovigilance centre.
An important change that must happen in Hungary’s healthcare ecosystem is the implementation of patient registries and the collection and utilization of health data
Please introduce yourself and give your insights on the Hungarian healthcare landscape since arriving in 2017.
I am Slovenian and have been working with Roche since 1996. I am a pharmacist by background, working in an outpatient pharmacy first, then starting in Roche as a medical representative. Since then I have gone through nearly all possible steps in the company until becoming general manager of Slovenia in 2010. I moved to Hungary in June 2017 and am leading a great team of enthusiastic people with our common mission. Our mission is to close the gap between the Hungarian and European patients’ outcomes by building partnerships with Hungarian patients and the healthcare system’s stakeholders, utilizing Roche’s portfolio and beyond.
When coming to Hungary I realized how two markets can be so complex and different despite being just next door. For example, in Hungary, life expectancy is five years below the European average. The numbers show that Hungary is facing many healthcare challenges and that the system as it is currently is unsustainable. It would be good to have a stronger government policy to address this.
Roche is the global leader in oncology. Given that the survival rate of cancer patients in the country is less than 50 percent compared to the European average of 55 percent, what do you see as the necessary reforms to improve treatment in the country?
Yes, the cancer-related mortality rate is the highest in Hungary among European countries according to OECD statistics. We have 38 percent more deaths due to these diseases than the country with the lowest death rate – Switzerland. Hungary loses most patients between 40 and 60 years old due to cancer. They are the most active age group; the loss of them is not only a tragedy for families, but also a loss for society and the economy.
We see that bringing innovation to Hungary alone will not change this statistic. The biggest challenge Hungary faces is that oncology patients enter the physician rooms to receive treatment at a very late stage. In lung cancer, 49 percent of patients in Hungary are in stage four, and combined with stage three, this figure increases to more than 70 percent of patients. We see that mortality rates are shifting slightly, but if patients are being diagnosed so late in the disease, there is little that can be done even with the most innovative medicines.
Therefore, as a company, Roche will strive to leverage prevention and early detection with appropriate screenings and diagnostics, and then deliver innovative therapies. While the quality of care is rather good in the hospitals, there must be a national focus on getting patients in earlier. In this regard, Roche can play an essential supportive role throughout the entire patient pathway. As Roche, we already have a strong diagnostics business unit in addition to pharmaceuticals. What we are doing is educating doctors and sharing best practices from other countries with pathologists.
Currently, the pharma industry is contributing heavily in terms of preventative care. In the future, the authorities should realize that in order to ensure that all patients can be properly diagnosed, there must be a reimbursement of diagnostics. This will save money in the end by making sure that patients are getting the right treatments necessary for their health.
What other key changes do you see as necessary for the development of healthcare in the country?
Just like in other countries, the cost of healthcare in Hungary is increasing at least twice as fast as the GDP growth. The clear solution is moving from paying each individual box of pharmaceuticals to a value-based healthcare system. This is one of the key avocation issues for Roche in Hungary.
To achieve such a financial structure, an important change that must happen in Hungary’s healthcare ecosystem is the implementation of patient registries and the collection and utilization of health data. This will help to monitor the health outcome of treatments and best determine how efficacy can be measured.
Hungary’s healthcare system is very centralized which is an important advantage in this context. The local government has already implemented an electronic health record system within the past year, and while there are some registries across various therapeutic areas, there is still no national framework. The future of healthcare is digital, and this must be embraced in Hungary too.
How can pharma companies like Roche be a partner to Hungarian healthcare stakeholders in order to achieve these targets?
The pharma is often perceived as an industry that only takes money by selling expensive drugs. To combat this, we started several CSR programs in which we involve other healthcare stakeholders to help people in need. Furthermore, our relationship with the government is continually improving and we are building trust. We have high hopes that the healthcare system will move in this direction, but the question is how quickly this can happen. However, I believe the more discussion there is between the industry and the health authorities, the higher the possibility of success for this transition.
Since 2016, only 48 new drugs have been granted reimbursement in Hungary compared to 71 in Bulgaria and 69 in Slovakia. How are you navigating this barrier to innovation?
One thing that is rather unique in Hungary is individual requested reimbursement of products. This allows certain innovative products to be semi-reimbursed for specific groups of patients. However, this is a huge administrative burden because, for each individual, a doctor is obligated to submit documentation to the healthcare payer who then must review the request and make a decision on a case-by-case basis. As Roche, we are doing rather well within this individual reimbursement, but again, the products are not fully covered. What we hope to accomplish in the future is to receive full reimbursement for all our products without administrative barriers.
To give an example, one of our metastatic breast cancer treatment was registered by EMA in 2013 and it was available only upon individual request until last year when the drug was reimbursed in Hungary. However, we have another medicine for lung cancer which was given European approval and granted reimbursement in Hungary last year in only ten months.
While the conditions are challenging, you can see we are doing well in gaining reimbursement for products that have been approved by the EMA most recently. The latest reimbursement was published in October 2018, after about two years, in which five of our products were included.
While the process is not easy, high efforts from the industry, the doctors, and the National Health Insurance Fund (NEAK), things are still moving. From here, we hope to see reimbursement publications without limitations and with a higher frequency. Even for individual reimbursement, submitting the application to final approval from NEAK can take up to two months, which is a long period especially in critical fields like oncology.
Now that Roche is celebrating 35 years of presence in Hungary, how is the affiliate positioned within the country?
Roche has a very strong footprint and commitment to Hungary, and we are even reinvesting three-quarters of our revenues back into the country each year. Not only do we have all three business units of Roche present in the country – pharma, diagnostics, and diabetes care – we also have a shared services and solution center and a new pharmacovigilance hub, which opened in September. The PV HUB Budapest is responsible for 23 European countries and 6 countries from Balkan Peninsula. Not only does Roche employs over 1000 people in Hungary, we have a very strong clinical trial presence, and on top of that, we signed a three-party agreement with the government and 77 Elektronika Kft, a local diagnostic company, to launch and market the Cobas 6500 system worldwide.
During our 35 years in the country, we have introduced more than 70 innovative products focused on meaningfully improving health outcomes. Or medicines span the therapeutic areas of oncology, haematology, immunology, neurology and pulmonology.
What was the rationale for selecting Hungary as the location for Roche’s new PV HUB?
Hungary’s central location in Europe, a wide set of language skills and high-quality education make the country an attractive choice for such investments. Furthermore, the support coming from local stakeholders like the National Institute of Pharmacy and Nutrition (OGYÉI) and the Hungarian Investment Promotion Agency (HIPA) were contributing factors as well. There was a huge willingness and openness locally for bringing the PV HUB to Hungary, which differentiated us from other potential locations.
We were pleased our new offering here in Budapest would create 25 more highly skilled roles over the next three years and play a critical role in ensuring the safety and wellbeing across Europe. The team will play a crucial role in capturing and analyzing data from our clinical trials and real-world use of our medicines.
To what extent is Roche participating in clinical research in Hungary?
In 2018, Roche involved many Hungarian patients in clinical trials across 150 sites. In total, we conducted 82 research studies across six therapeutic areas being oncology, immunology/inflammatory disease, neurology/psychiatry, pulmonology, hematology/nephrology, and ophthalmology. The majority of our trails are still in oncology, but we are also entering more into neurology and ophthalmology areas as well. Most importantly, Roche made payments totaling to HUF 1946 (USD 6.5) million and generated a cost savings of HUF 6161 (USD 20.5) million for the Hungarian drug budget. Our clinical trial is one of, if not the strongest, programs in Hungary can create jobs and encourage Hungarian physicians to remain at home and we are very proud of this.
In recent years, there have been changes in the Hungarian clinical trial environment and a loss of competitive, which creates a challenge for the industry here. Consequently, comparing the number of patients involved in Roche trials from 2017 to 2018 is almost half. However, we are still committed to continuing our clinical trials here in the country. I would also like to point out that the increase of personalized medicine, which requires a smaller patient pool is a trend that also contributes to fewer patients being involved in trials.
Having come to the country two years ago, what advice can you offer to new general managers coming to Hungary for the first time?
Do not live in your comfort zone – go beyond and work with others towards a common goal. In Hungary, the market can be challenging, and things take time to achieve. Therefore, I feel that the proverb “if you want to go far, go together” fits well with the mindset necessary to success here.
After more than two decades in the organization, what has kept you so loyal to the Roche team?
With all the experiences, I have from Roche, I have realized that my purpose is giving unconditionally and to help others. With Roche, I have many opportunities to do so. Despite not always being easy, I believe in “where there is a will there is a way”.
What long-term vision do you have for Roche in Hungary?
15 years from now when Roche will celebrate its 50th anniversary in Hungary, I would hope for the company to be considered the true partner to the Hungarian healthcare system. I also expect that through continuous work, the Hungarian mortality rate to drop significantly and reach the best life span in Europe. I believe this is possible to achieve with a unified effort from all health stakeholders.
What final message would you like to deliver on behalf of Roche Hungary to the Hungarian healthcare stakeholders?
The conditions in Hungary are positive with almost full employment and with the highest GDP growth in EU (around five percent), so it is time for Hungary to put healthcare as a priority on the political agenda and closing the gap between the Hungarian and European patients.