Maria Fernanda Prado, managing director of Janssen Turkey, elaborates on the unique dynamics at play in Turkey; an important emerging market. Prado addresses the challenges, advantages, and opportunities that exist in the market and speaks to the dedication Janssen has placed into the vibrant country.
How has your long-standing experience in the Brazilian market helped you to take over the Turkish affiliate and adapt to a new market environment?
I have been part of emerging markets my entire career, which prepared me for the move to Turkey. Of course, each country has its own specificities, but at the end of the day, the trends and challenges are quite comparable.
Emerging markets are characterized by fluctuations; this trait is simply part of the nature of these markets. From my experience in Brazil, I could apply my skills and knowledge in Turkey effectively. The differences are not as drastic as one might anticipate, despite the geographical and cultural disparity.
Looking at the Janssen portfolio, emerging markets are almost at the same product launch stages. Furthermore, Janssen does not implement distinctive portfolios across countries, so the company’s main mission of improving patient access to innovative medicines is transferable in all our markets.
What are the defining attributes of the Turkish ecosystem that you have realized since your arrival in the country?
When it comes to physicians and healthcare professionals, the level of aptitude and access to scientific resources are comparable to other markets. As the world continues to become more globally connected, the gaps in scientific expertise and practices are much smaller than they may have been in the past. On the other hand, drug access is a quite peculiar area in Turkey. For instance, self-pay models and private insurance healthcare coverage, especially in specialty therapeutic areas, are commonplace in emerging markets; in this regard, what makes Turkey unique is the impressive extent of its universal healthcare access.
Due to the robust reimbursement system in Turkey, the private sector does not play a crucial role as in other emerging markets on the drug expenditure aspect. While there are some co-payment systems in place, 98 percent of Turkish patients are covered by universal access; a remarkable accomplishment for this category of the market.
What are the challenges you have seen being faced by the Turkish market and possible solutions to these issues?
In all countries, universal healthcare coverage is a vital issue; even more so in emerging markets. In these countries the population tends to be younger than in mature markets; this holds true for Turkey especially. Inspecting the broad coverage of care, it is easy to identify that serious consideration must be put into how access to innovative medicines can be sustained. As the population will eventually age, there will be new challenges to be faced in order to meet the needs of the population. One of the main questions that payers are asking is how to support patients once the population dynamics that exist today begin to change.
One solution would be to recover healthcare spending in proportion of GDP, which has been decreasing in Turkey or to reprioritize the way the current healthcare budget is being allocated. Outside of Turkey, basic treatments are funded by co-payment schemes, which help source innovation and ensure that complex diseases are fully insured by the system. At a certain point, a decision will need to be made on how to keep this very successful healthcare system sustainable into the future. This will require adaptation in the current system.
How would you assess the relationship between the government and industry stakeholders in Turkey?
Turkey has fulfilled the leap that OECD had gone through in 30 years in just 8 years thanks to the Healthcare Transformation Program. Under the scope of this program and as described in the 10th Development Plan, the satisfaction in healthcare services has improved dramatically.
In the transformation journey, innovation has been a powerful tool to enable the government to deliver targeted healthcare outcomes. With the changing demographics of Turkey, innovation and advanced technology will continue to be a top priority for healthy ageing.
Turkey’s Development Plan shows how the government and the industry are both aligned for the future. As an international company, we want to see Turkey as a global player in healthcare and the government has shown this aspiration as well. Now it is time to take the necessary steps to better develop the ecosystem to attract investment into the country. We, as Janssen Turkey are ready to join forces in collaboration with all local stakeholders, particularly with the government and academics to increase patient access to innovative treatments and solutions.
What do you see as the role of the managing director in fostering market access in Turkey?
One critical role of managing director is being the voice of the organization and looking at the entire healthcare ecosystem to engage with all local players and understand how we can contribute to Turkey as a whole. As a managing director, there is a need to lead these discussions and create a conversation with the different local stakeholders; especially on how we can improve as a partner. This is something I have brought with me from my previous experiences in Brazil.
Internally, we are investing resources into the area of accessibility. Janssen has a matrix structure which allows us to work with different areas. As a whole, Janssen addresses this issue not only from the access team’s point of view but also from a holistic perspective, looking at patient and physician needs as well. The entire company is engaged in access because there is no more of an important point of motivation for Janssen than being able to reach our patients.
In light with the government’s Vision 2023, how does Janssen contribute to the development of Turkish ecosystem at large?
Janssen has been in Turkey since 1999 and has since launched more than 33 molecules here, which is a huge commitment and investment into the country. Regardless of any fluctuation in the economy, Janssen is here to stay.
One of the key agendas of the Turkish government Vision has been localization. To engage in this agenda, we need to understand how we can support the local needs and deliver value to the country. As Janssen Turkey, we have already localized 5 molecules which consist of 12 forms and more are under assessment and feasibility. At the moment, we’re working hard to conclude the localization of 2 novel products, 1 oncology and 1 rare disease treatment, with our local partners.
We also stand as one of the largest investors in clinical trials in the country. Since 2009, we have invested almost USD 40 million in clinical studies in Turkey and we continue to increase our investments every year. The clinical research areas that we focus on are oncology-haematology, major depression, cardiology and schizophrenia.
In 2017, Janssen Turkey became the pharmaceutical company with the 2nd highest number of clinical studies started in 2017. Thus, we provided a significant added value to the country’s economy as well as R&D infrastructure.
Beyond localization and R&D, we offer value-added healthcare solutions to society. We work relentlessly at Janssen to empower the healthcare system, to contribute to the education of patients and their caregivers, and to help to relieve the burden of diseases on the society. I like to give 3 examples of our value-added healthcare solutions:
Given the fact that individuals living with schizophrenia should be supported by psycho-education aside from medication therapy, we have started implementing Healthy Living Guidelines psycho-education modules in 2016. Schizophrenia patients in over 60 Community Mental Health Centers across Turkey are benefiting from psycho-education modules.
We have contributed to the process of providing 70 centres with the Treatment Alliance Portal that offers appointment reminder services via phone calls to support treatment adherence of patients.
Since 2014, we focus on increasing awareness about the Community Mental Health Centers (CMHC) where people diagnosed with schizophrenia and bipolar disorder improve their social communication skills and their functionality. Today, about 56.000 patients continue their treatments being reintegrated into society.
On a personal level, over the past two years as managing director, what is your assessment of your priorities, initiatives, or accomplishments you are proud to have realized?
As Janssen, we have the same strategy across all our countries. We want to make sure patients living in emerging market have the same level of access to innovative treatments and the latest products available as with patients living in the rest of the world. We have had the opportunity to improve access in immunology, neuroscience and oncology in Turkey which are priority therapeutic areas for Janssen globally. Internally, we arrange our organization to reflect the therapeutic areas under which we are focusing. Our corporate structure allows us to better leverage our skills of each therapeutic area and have a deep understanding of the physicians, payers, and stakeholders to better meet their unique needs.
You have worked in many innovative companies before and seem to have settled at Janssen. What sets the company apart from its competitors?
Our credo is completing 75 years and is very unique showing the level of dedication Johnson & Johnson has for patients, caregivers, healthcare professionals, customers, business partners, employees and communities. Our credo challenges us to put the needs and well-being of the people we serve first.
At Janssen, as the pharmaceutical company of Johnson & Johnson, we have an openness to collaboration and local partner, better engaging with our stakeholders. As an innovative pharmaceutical company, we push the boundaries of discovery with our research and development activities to address future medical needs and to offer meaningful solutions. The company has a philosophy to connect locally and bring our mission to all markets as a leader in innovation. We bring the best we can to all our areas and Turkey is truly an important part of Janssen now and for the future.
