Novo Nordisk Switzerland’s Mads Stoustrup introduces the affiliate’s remarkable process on bringing innovative diabetes and obesity treatments to market in the past four years, the road still to travel to ensure better outcomes for chronic disease patients in Switzerland, and the leadership he hopes to cultivate during the COVID-19 pandemic and beyond.
When we last spoke almost four years ago your main priorities were to launch and drive the commercialisation of new products and have a greater input into care standards for Type 2 Diabetes (T2D). How have you progressed towards meeting these targets and what are your priorities today?
Change is part of the plan and a lot of things have happened since we last spoke. It has been exciting years for Novo Nordisk Switzerland, and we have been able to launch many new products very successfully with the ultimate aim of bringing innovation to patients and driving better care.
As part of our ‘Win Switzerland 2020’ strategy, which has been in place for the last three years, we aim to drive better care for patients, shape the overall healthcare environment, and develop even more of an externally-oriented business mindset. This strategy has already borne fruit and we are close to reaching our ambitious target by the end of 2020. This success is part of the reason why the affiliate has been elevated to report directly to the SVP of Northwest Europe rather than to a geographic business area.
In terms of new product launches, Ozempic®, our once-weekly GLP-1 treatment, entered the Swiss market in 2018 and it has already achieved the status as a big brand in the Swiss diabetes market. This Summer we launched Rybelsus®, so far the only oral GLP-1 treatment for T2D, which we are hugely proud and excited about.
Obesity is also a key focus area After three years of tough negotiations, we finally achieved reimbursement in Switzerland for our prescription weight-loss product Saxenda® in April 2020, and it is now available to patients in specialised obesity centres.
What has changed in terms of the medicine pricing environment in Switzerland?
The Swiss government’s first and second cost containment packages is a significant challenge for the pharmaceutical industry. We, unfortunately, see an increasing focus on the costs of medicine rather than on the quality of care, innovations and outcomes. So far, we have been successful in getting our treatments approved for reimbursement, but the market situation is definitely more challenging and unforeseeable than it was five to ten years ago.
How could improvements in market access for innovative products drive better outcomes for both Novo Nordisk and for patients?
Diabetes patients in Switzerland wait too long to access innovative products and many T2D patients are still using older medicines like DPP-4 inhibitors and SU. Therefore, there is a major opportunity for patients to start using GLP-1 treatments much earlier. This class of drugs can help get patients’ illnesses better under control and have beneficial weight and cardiovascular effects.
The COVID-19 pandemic has shone a light on the higher risk that patients with chronic diseases face.
COVID-19 has elevated the discussion about the treatment of chronic diseases such as diabetes and obesity as well as the importance of a good relationship between patient and doctor. Over the last few months, the focus has been on the imminent COVID-19 crisis. But we need to also have a discussion on how we bring these chronic patients under good control and what it means for physicians and the HC system. It is very important to have your diabetes in control and making sure that you lose weight and manage cardiovascular risks. We see this as a trigger point.
How serious a problem is obesity in Switzerland, what is being done on the prevention level, and what role do you foresee for Saxenda® in fighting this battle?
Obesity is often explained straightforwardly: if a person consumes more calories than they need, they gain weight. However, it is not that simple; obesity is a complex chronic disease and losing weight is not just a question of eating less and moving more. It is about more than weight. Obesity is a complex chronic disease influenced by genetics, physiology, environment, job, education and what is going on in the brain. Meaning that an understanding of all of these factors is critical. It is also associated with other diseases, including T2D, heart disease, certain types of cancers making it a huge societal problem.
Not to mention the stigma and bias against people with obesity. Millions of people are suffering with this disease every day, including many in Switzerland, but with the right care, they can achieve weight loss, make a difference to their health and improve their quality of life.
Our product is one part of the solution in conjunction with a healthy diet and regular exercise. After a three-year reimbursement discussion, it today represents a major opportunity for improved outcomes for people with obesity. In Switzerland, Saxenda® is now reimbursed and can be used within specialised obesity clinics, of which there are 75. In the long-term we are very optimistic about the product and the good that it can do for patients.
Novo Nordisk also has several other promising obesity treatments in its pipeline which stand to make a great contribution to patient’s quality of life and to society as a whole.
In chronic diseases, the use of digital tools to bolster patient-doctor relationships will be fundamental to success. Novo Nordisk has always been ahead of the curve on this issue; what products or initiatives are you looking to bring to market next?
Digital health is close to our hearts as an innovation- and patient-focused company. In diabetes, we have several partnerships with other companies in this area and we are preparing to launch our new digital pens in Switzerland. I see great potential in these products to help diabetes patients better manage their disease and achieve better health outcomes as we move towards a more personalised, patient-centred care paradigm.
However, as a pharmaceutical company, the impact that we alone can have with these technologies is limited. As we cannot communicate directly with patients, it will be up to the doctors and patients themselves to choose how, and in what combination, they use digital pens and Continuous Glucose Monitoring (CGM) systems from the likes of Roche and Abbott.
There is great opportunity for further development in this field, but different practitioners will utilise the technology differently. It is akin to how people use their smartphone – some have hundreds of apps whereas other just use the device to make phone calls. Our role, in collaboration with other companies, is to provide physicians with the opportunity to use these solutions for the benefits of patients.
How does the fragmented nature of Swiss healthcare play into your ability to gather reliable and comprehensive national level health data and how are you working to shift the needle on this?
Switzerland is a very decentralised country with a decentralised healthcare system. There is a great deal of decision-making power at the Cantonal level, makes gathering national data complex and challenging. There is not one national registry which everyone can use, in contrast to my home country of Denmark or any of the Nordic countries, where there is a long tradition of having national registries. In the case of obesity, physicians need to report back to the patients individual health insurance companies in order for the drugs to continue to be reimbursed. Each obesity centre is currently using different tools, so it would be helpful to have a common tool used by all.
The case that we, in collaboration with the other members of Interpharma, are bringing forward is that a more holistic and comprehensive health data ecosystem would benefit both individual patients and the health system overall. We can start and facilitate the discussion, show what the value could be, and do some pilot projects but in the end, it is not something that we in the pharmaceutical industry alone can or should solve.
2019 was a good year for Novo Nordisk globally, with a return to growth, as well as for the Swiss affiliate with its elevation to standalone status. Beyond what is sure to be a challenging 2020 for every company, what are your hopes and expectations for 2021 and 2022?
We began discussions about our new strategic plan this summer, and we see multiple opportunities but also some challenges. As an innovation-driven company, our aim for Switzerland has to be to bring new innovations to the market that improve patients’ lives. Our most recent products in T2D and obesity represent a huge growth opportunity. These two areas will be our major growth drivers in the next five years in Switzerland and will have a significant effect on patients. However, it should not be forgotten that we still have a very solid insulin franchise with great products coming up, digital health products, and a haemophilia portfolio for which we also foresee growth.
Novo Nordisk’s entire haemophilia portfolio is represented here, but it is a very competitive market with many big players and an explosion of innovation in the last few years. This level of competition and innovation is a challenge but, at the end of the day, it is good news for patients and we are confident of being able to compete in this field.
What sort of leadership style would you like to cultivate and how different might it be from what has gone before?
2020 has been very challenging for all of us. However, it has also been a year of reflection on what I am doing personally and what we are doing as a company. I have reached the conclusion that our two areas of focus will be ‘purpose’ and ‘people’.
Our new corporate social responsibility strategy, ‘Defeat Diabetes’, has been very important and reminded us of our purpose, which has remained the same for nearly 100 years and is more important now than ever. Defeating diabetes is our social responsibility but it is also how we help society rise up to the challenges that it faces. We have a reinvigorated focus on prevention, bending the diabetes curve, providing access to affordable care for vulnerable patients, and driving innovation to improve lives, thereby helping both society and healthcare systems.
In terms of people, we are working on hiring the best people possible in order to drive together towards a common goal. Getting the best people to work for us is important, but we also need strong and passionate leadership. Thus being open, honest and treating everybody with respect. At Novo Nordisk Switzerland, I am very proud and humbled about how our team stepped up and worked together in the face of a challenging pandemic situation.
How exactly did you and your team respond to the COVID-19 pandemic?
One late night early on in the crisis we set out our Swiss strategy across four pillars and have kept them as a framework ever since. The first was to protect our employees, reducing their stress where possible and safeguarding their health. The second pillar was safeguarding patients in terms of ensuring that the products they needed were available and helping those in need openly and honestly. The third part was about managing the business, ensuring that we sustained our operations, including our clinical trials. The fourth and final pillar was developing the business and culture of tomorrow, looking at how we could foster an agile, creative and collaborative mindset for the future.
Developing the business and culture of tomorrow has resulted in us running “agility weeks” and using the different technology options in a much smarter and better way, then we did before. We are engaging with our customers and stakeholders virtually and been experimenting with many new way of collaborating and commercializing our products.
I am extremely proud of how we as one Novo Nordisk Switzerland team has stepped up and managed this situation.
What do you want people to think of when they hear Novo Nordisk Switzerland?
Purpose and people. Whatever happens, we always have the patient in mind and a patient-centred approach. With this, we will find solutions to the challenges we are facing and drive the right decision making within our therapeutic areas. This responsibility, at least for me personally, is something I always think about.
Over 100,000 people in Switzerland are treated with our products every day, which is something I take very seriously and also feel a big responsibility for. They are counting on us, the quality of our products, and how we conduct our business.
