After years of steady and predictable growth, the pharmaceutical sector is entering a period of flux since many of the conditions under which it operates are fundamentally changing.
Erik Roos, CEO of one of the fastest growing pharma companies in SA, Pharma Dynamics, says globally the business of pharmaceutics is changing rapidly and refers to two major shifts that are disrupting the sector.
“The first will see a change in the balance of power across the healthcare value chain as governments and medical aid providers start to exert more pressure on pharmaceutical companies to drop their prices. The second involves a move from reactive healthcare to prevention, which is bound to attract new entrants and unsettle the status quo.
“As populations grow, the demand for healthcare increases, which is why governments and medical insurers are scrutinising costs and are requiring greater transparency around medicine prices,” explains Roos.
Value-based pricing and outcomes
Medical aids, hospitals and patients are no longer prepared to pay for healthcare products, services or procedures, without guarantees. They want fees to be dependent on certain outcomes.
As an example, Roos refers to the US, where some pharmaceutical companies have signed ‘value-based’ contracts with medical insurers whereby the latter receives a rebate or discount if a patient’s symptom(s) or health risk hasn’t been reduced to an acceptable level. “The converse also applies by way of an incentive programme should a medication significantly improve patient outcomes.”
Advances in technology
“Scientific advances have also allowed researchers to gain a better understanding of genetics and a patient’s potential for disease, as well as what treatment the patient will respond well to. This means medication can now be tailored and targeted at specific patients rather than the one-size-fits all approach of the past.
“Pharma companies are also starting to recognise the importance of partnering with technology businesses in order to tackle the burden of disease. In the coming years, we will see more health firms combining devices, software and medicine, which will boost doctors and researchers’ ability to treat and monitor patients, while tracking the efficacy of certain medicines.
Preventative care model is the way of the future
The South African healthcare system, like most other systems around the world, is based primarily on a reactive care system where it waits for someone to become ill before treatment is provided.
According to Roos, recent years have seen a shift toward preventative care, but for the most part, the system still isn’t equipped to prevent the onset of disease. He says the only way to effectively manage chronic diseases of lifestyle, which is at an all-time high in SA, is to introduce public health incentive programmes to encourage individuals to take better care of their own health on a much wider scale than is currently done. Many of these lifestyle illnesses are a result of stress, poor diet, sedentary living, smoking and drinking too much alcohol and can be addressed affectively through behavioural change counselling.
“Curbing the onset of illness, especially diseases of lifestyle, such as high blood pressure, heart disease and diabetes, is the holy grail of healthcare transformation and sustainability. Proactive care solutions should include screening individuals based on known algorithms to ensure preventive action is taken long before the onset of symptoms or disease,” he remarks.
Non-communicable diseases are estimated to cost SA in the region of R15-bn annually, which is strangling SA’s already heavily burdened healthcare system.
Consumerisation of health
“As healthcare costs increase, patients are less willing to tolerate inefficiencies and delays, and are looking outside a traditional doctor’s room for medical advice. Many are turning to the internet and apps where they can connect with a certified doctor online from the comfort of their own homes 24/7.
“Increased competition in the healthcare sector is unavoidable and ultimately gives more power to the patient to choose a provider outside the traditional healthcare ambit.”
More SA consumers opting for generic medicines
Roos says the tables are turning for generic medicines in SA as more doctors and consumers opt for affordable, yet effective alternatives to expensive brand name medication.
The local pharmaceutical market is growing at just over 9% in value and he ascribes most of this growth to the increased demand for generics.
“Originators have steadily lost market share over the last five years primarily due to many blockbuster medicines having lost patent protection and a push by government toward affordable medicines. While some may argue that the dominance of generics may dissuade originators from developing innovative medicines, the 1984 USA Hatch-Waxman Act, which led to global reforms in medicine policy and pricing, was designed to balance the competing interests of both innovator and generic pharmaceutical companies.
“Nearly every therapeutic class currently has at least one generic equivalent available and sales of over-the-counter (OTC) generics now also outstrip brand name products by almost R1-bn in value and more than 53 million units.
“In SA, generics are fast becoming the pillar of healthcare,” remarks Roos. “Generics have and continue to save government millions in healthcare costs and makes medicine accessible to the most vulnerable in society.
“As the generics industry enters the post-blockbuster era in the next few years, where there will be fewer opportunities to ‘genericise’ small molecule branded medicine, the pharmaceutical industry will move toward more advanced medicines. Generics firms have kept pace by moving from simple molecules to more complex combinations and technological advances targeting niche classes, which opens the door to new markets and opportunities for the sector.”
The National Health Insurance (NHI) bill, which will allow government to purchase health services on behalf of patients from public and private sector providers is set to pave the way for universal health coverage in our country, however according to Roos it still faces many challenges, which requires a complete restructuring in the delivery of healthcare in order to be successful.