Nabil Daoud, president of Lilly Spain, Portugal and Greece, highlights the importance of Lilly’s Spanish operations to the global group; Spain being the only country

outside to hold manufacturing, pre-clinical research and commercial sales functionalities. Furthermore, he gives insight into his strategy to deliver the company’s exciting pipeline and his priorities and challenges in the future.


How have the first 13 months in your current role been?

The first thing that comes to mind is that we have an amazing group of professionals working for Lilly in Spain, with over 1000 employees, many of whom have a long-standing tenure with the company. It is a very stable organisation with a committed and passionate workforce. Second, I have been impressed by the robustness of the Spanish healthcare system. Spaniards are extremely proud and positive about their public healthcare service, and for good reason! It has excellent infrastructure and world-class healthcare professionals.


How different is it working in Spain compared to your positions in the past?

In my previous role, I was in charge of South Asia, Africa and the Middle East. I had to deal with a lot of complexity in terms of doing business, operating in many countries with very diverse economies, social and healthcare structures. As a result, you end up spread thin and get fewer opportunities to go deep and build lasting external relationships.

In Spain, Lilly operates in the full spectrum of the value chain of the pharmaceutical industry, which allows me to connect earlier in phases of R&D and manufacturing with our customers. I am also able to develop more depth of medical knowledge in the different therapeutic areas in which we operate.


What are your current priorities?

First, to build and develop a strong and engaged team and invest in growing emerging capabilities mainly in areas of analytics, digital marketing, RWE and market access.

Second, transform the experience of our customers by offering more diverse educational opportunities and services. We want to generate relevant medical evidence that can help our customers better understand who can benefit most and who will benefit less from our medicines… and communicate this evidence in a simple and effective way. In parallel for many of the diseases we operate, we believe we can offer a series of educational services for patients which will can help improving adherence to therapy and outcomes.

Lastly, to deliver growth through the launch of innovative medicines. In the first part of this decade, Lilly has declined as we were very dependent on two large molecules that were losing exclusivity. This coincided also with the period of economic crisis in Europe and a relatively dry pipeline for new molecules. Since 2015 though, we have turned this page and started growing again, mainly thanks to new launches. Our internal goal is to launch at least 20 new molecules in 10 years which is unprecedented for our company.


What is the strategic importance of Spain for Lilly?

We are proud to be one of the 6 countries with a pre-clinical research facility which was founded 35 years ago and has grown consistently in size and importance since then. It is today the largest private chemistry facility in the country. This centre has achieved what very few researchers achieve in their career, to bring a molecule completely synthesized in our labs in Alcobendas to become a medicine approved by the FDA and EMEA for treatment of metastatic breast cancer and that is now in process of being launched globally by our company

Additionally, in 2018 in Spain, Lilly undertook 75 clinical trials, the largest number outside the US for the company. This is an excellent achievement and is not only a credit to Lilly Spain, but to the excellent quality of the Spanish healthcare infrastructure, research centres and health care professionals which is second to none.

Finally, we also have one of our main manufacturing sites for solid formulations in Spain, exporting medicines to more than 120 countries.


How is Lilly’s portfolio represented in Spain?

Historically, Lilly Spain has been mainly present in the fields of psychiatry, diabetes, and cancer.

After the loss of exclusivity of our main psychiatry medicines we have operated a shift to diversify our portfolio and expand in new therapeutic areas like autoimmune diseases, and pain. In parallel, we have expanded and consolidated our presence in diabetes and oncology. We have launched one or two products each year since 2014, including two oral diabetic medications with our partners, Boehringer Ingelheim, a once a week injection in the GLP-1 class as well as new medications in the fields of gastric cancer and breast cancer.


How do you evaluate market access in Spain?

It is possible to gain access at a central national level relatively quickly, though the fragmented market with 17 autonomous communities adds complexity and sometimes further delays, particularly in the hospital sector. Most recent pharmaceutical innovation is delivered through hospitals, so once you have approval at the national level, you must then go and negotiate with each region, and in some cases, with each hospital to have your product added into their formularies.

This brings the challenge of delivering drugs quickly to market, though also in certain instances it can become an opportunity. For example, it can allow you to pilot innovative market access strategies, and measure outcomes in more creative ways to then execute pay for performance agreements. It is a lot easier to execute in smaller regions or with specific accounts, learn, adjust and then launch the scheme on a wider scale or at a national level.


How do you deal with fragmentation in terms of assembling your team?

We have built up a team of Key account managers who are dedicated to navigating regional and hospital access and they support our entire portfolio. This is a common approach in the market. Nevertheless, it is always tricky when you have such a wide specialty portfolio as it is challenging to be proficient in so many therapeutic areas; therefore, it is a real team effort, and they need to be able to tap into their counterparts from the medical department to offer the right answers and value to our customers.


Does undertaking such a large number of clinical trials help speed up market access?

Absolutely. The experience of big reference centres is very much valued by payers and regulators at the moment of assessing the value of a new medication.


How are you changing your service offering to be more involved at the level of the overall care of patients?

We see that with chronic diseases, basic changes in lifestyle or simple adherence to treatment can result in drastically better outcomes. We have therefore developed patient support programs that we offer to healthcare professionals to support their efforts in the education of patients. These programs will include for example recommendations around nutrition, sports, lifestyle changes and the like, in addition to access to online or phone support to educate patients around questions related to their disease or administration of the therapy recommended by their physician


How well prepared is Spain for risk sharing style payments?

As mentioned earlier, in this case, the fragmentation of the healthcare system can facilitate the establishment of risk sharing programs… The biggest challenge for this sort of innovative access schemes is to get consistently good quality data to measure outcomes. This is usually easier to see at an account or regional level, which has allowed us to pilot many such deals over the past few years. The challenge for Spain will then be to scale up at national level a deal which has proven to be successful in a specific region as data collection is not always consistent from one place to another.


Lilly is well known for establishing partnerships. How is this portrayed in Spain?

On the scientific and R&D side, we work with many public institutions, universities and hospitals. Our chemistry lab has, for example, a long-standing collaboration with the CNIO with whom we collaborate on many cutting-edge research projects in cancer.

On the commercial side, Lilly has a global alliance with Boehringer Ingelheim which was established in 2012. This has been a very successful model and thus far has resulted in three large compounds that have been developed and commercialized together globally including in Spain. Additionally, we have also sometimes launched molecule with local partners in the form of co-marketing agreements whenever we needed to complement our reach to primary care physicians where Lilly has limited presence.


You are the president of the Lilly Foundation. What role does this body play?

The Lilly Foundation was founded in 2001 with the objective of promoting science, medicine, and humanism in Spain.

Under the chapter of science, most notorious activities include our annual Lilly foundation awards recognizing the best research work in pre-clinical and clinical fields as well “citas con la ciencia”, forums open to the public and now reachable through social media to promote and demystify science among society. Under the chapter of medicine, I would highlight our medical education chair in collaboration with UCM as well as MEDES ¨Medicina en Español” which is the largest online search engine for medical literature in Spanish. Finally, under the chapter of humanism, several initiatives and publications looking at promoting a more human, patient-centred medicine.


What are your challenges looking ahead?

The budget for public healthcare in Spain as has dropped considerably since the last financial crisis and does not exceed now 6.3 percent of GDP, well below the average of EU. As a result, the pharmaceutical market reached back in 2018 the levels it had in 2009 prior to the crisis, which means that it took nearly a decade to recover while the ageing of population and increase in the prevalence of chronic diseases kept increasing. Therefore, a clear challenge lying ahead is how do we find space for innovation in this environment of extreme cost containment. This will only happen if we manage to shift the mindset of considering medications as a cost to considering them as an investment, given the multitude of studies demonstrating that each Euro invested in medications returns between 2 and 7 euros in productivity, future cost avoidance. Another challenge will be to embrace the opportunities that connected care and big data can offer to speed up research including real-world evidence studies.


And what are your ambitions in the future?

Take what we have here at Lilly Spain and make it better and better. In particular, it will require us to continue making this company a great place to work, to remain agile and attentive to the needs of our customers so that we are continuously seen as a preferred partner in our field and ultimately to deliver results which in our case means to contribute to discovery and development of new meaningful medicines that we can make accessible to the people who need it.