The Pharmafocus interview: Simon Jose
pharmafile | February 20, 2009 | Feature | Sales and Marketing | GlaxoSmithKline, Simon Jose, UK, partnerships, pricing
Like all his contemporaries in the UK, Simon Jose, GlaxoSmithKline’s head of UK operations has to focus on some of the ‘bigger picture’ issues in the pharmaceutical industry.
These include the well-known pressures of patent expiries, government demands for value for money in medicines, and the issue of transparency.
“When you look at the first two, they are creating an environment where industry is going through very significant changes in the way it structures itself,” says Jose.
“And overlaying that you’ve then got this whole industry perception-trust agenda, which is also very important.”
Patent expiries will hit some companies hard, and Jose says this is because many are not in a position to replace the lost value of older medicines with new ones. “If you value the projected pipeline against its existing sales base, the industry is currently generating a pipeline that would be equivalent to 60-70% of its existing sales base.”
This is, of course, not sustainable: “It tells you instantly we are going to experience some pretty far-reaching industry re-structuring, and we are already seeing that.”
Jose refers to the job cuts and downsizing seen across the global sector, but proffers that GSK itself is “not in too bad a shape.” He says it is one of only a few companies that has the potential to replace its existing sales base.
“The fact that GSK has a strong portfolio and pipeline – we believe we are at the top end of having that replacement power. This should give us some protection, but there is no room for complacency, and still a challenging time ahead.”
GSK has also recently been reinvigorated by the arrival of a new chief executive, Andrew Witty, who took over in May 2008.
Witty wasted no time in introducing a new direction for the company, including a more approachable management style, and an increased focus on emerging markets. Jose comments: “He has clearly outlined a new strategic direction for the organisation. And he has articulated these strategic priorities within the company and externally, so that’s been a very strong driver of the organisation.”
Under pressure
The next major challenge, according to Jose, is the rising expectations and pressures from governments regarding the value of medicines.
“In Europe the environment has shifted dramatically, because governments are getting much more involved and putting tighter controls on access, expenditures and value for money.”
He says this is a marked contrast to twenty years ago: “Then, if we found something that was new – just by the very nature [that] it was new or had some kind of different mechanism of action, it was generally adopted.”
But today companies need to provide more: “The industry absolutely has to deliver new innovative medicines of value to society. We’ve got to find them, develop them and bring them to market, and much more than in the past – they have to be different and have to add significant value.”
He says, “Any government funded health system has the right to want value for money. They have every right to have some form of rationing – call it what you will.”
Jose says governments around the world are “really starting to get their hands around value for money and access.”
This represents a huge challenge for the industry over pricing of medicines; healthcare systems across Europe assess the value differently, which makes it impossible to set a list price to meet expectations everywhere.
“It’s very difficult for us as an organisation to say we can pick a price that would be the right price for this healthcare system and that one, because actually you can’t do it.”
He cites France’s Transparency Commission as having a philosophy more rewarding of innovation, whereas NICE in the UK instead focuses on efficiency and cost-effectiveness.
NICE’s draft recommendations rejected GSK’s drug Tyverb for advance stage breast cancer last July, concluding it was not sufficiently cost effective. As with so many other drugs refused by NICE, Tyverb has been given the green light in many other western Europe countries, such as France: “So those health systems [in Europe] see Tyverb as being valuable. They’ve let it through and it’s being used – that means in their eyes, the price is right.”
But Jose says the UK model makes it difficult to demonstrate cost-effectiveness in end-stage disease and companies have to look at different ways of working with NICE. “We need to find a mechanism by which to adjust to that, and we have chosen to do that through a patient access programme.”
GSK, like other companies, has chosen to negotiate a pricing deal to make Tyverb more cost-effective, and Jose is now hopeful it will lead to approval within the next three months.
As part of the deal, GSK is offering to pay the cost of Tyverb for all eligible patients for up to the first 12 weeks of treatment, after which the NHS would only fund it for patients who continued to see clinical benefits.
“It is ultimately a win-win-win. So patients receive it, the healthcare system gets value for money, and we get a reward for innovation.”
Some commentators say such schemes should be employed only as a last resort, and are no reason to stumble over setting a price immediately.
But Jose indicated the nuances across European countries mean patient access schemes would become more common: “Whether it’s a last resort or not, I think over time different products might get treated in different ways. Ultimately our goal is to find different ways, different models and be flexible. Whether it’s in price, or in discounts or in access programmes.”
“Equally the UK Government needs to reward innovation and we need prices that sustain future R&D”. He says the pragmatic approach is now the only option: “Because frankly, there is little point spending billions of pounds and dollars researching these things if you don’t get them out into the market place because of price – that’s crazy.”
A question of transparency
Jose says external pressures have also prompted the industry to change in relation to ethics and transparency. Though he has concerns that people outside pharma don’t yet see it.
“Society has expectations of the industry, as do customers and governments. We are doing everything to make sure we behave in an ethical, transparent and professional way, where we have the patient at the centre of our thinking.
“That’s moved beyond ‘we ought to do that’ to people really believing that’s the way we should run our business. I don’t think society at large has really accepted it yet or see that is actually where we’re at.”
GSK has made efforts to lead in this field. It is stopping corporate political donations in the US to avoid accusations of inappropriate lobbying; and was one of the first to publish all clinical trial data online – something not yet required by regulators. It is also making public all donations to patient groups.
Jose says GSK and the sector in general have improved on publishing data, and on transparency overall, but says his comments shouldn’t be interpreted to mean it was unethical in the past.
“In the industry it’s changed, it’s absolutely changed. We’re tightening up and being much more explicit – we would never make a decision that would compromise the patient.”
He says it is clearly demonstrated when people join GSK from outside the industry, particularly on the medical side.
“You talk to some of them, their colleagues call them ‘gamekeeper turned poacher’ as they leave, but actually they are surprised at just how ethical, transparent and well run the business is when they get inside it.”
Jose adds: “We are not profit-mongering sales people trying to drive as much profit as we possibly can. It’s a perception some people have. We are here to deliver medicines of value that will improve and extend people’s lives. That’s why we exist.”
Jose talks with quiet confidence about his company and his industry, and believes business challenges need to be fully understood before they can be solved. His sense of perspective is conveyed in his advice to anyone who wants to follow in his footsteps:
“Seek a broad base, and don’t get wound up by trying to advance on one single route in the industry.”
Biography
Simon Jose chose science early on but opted for a commercial line when he joined the pharmaceutical industry.
After graduating with a degree in medical biochemistry from Birmingham University, he knew he didn’t want to use it for research, but at the same time didn’t want to lose the science entirely.
He says the natural choice was then to enter the industry on the commercial side, where he could still utilise his background.
Jose began as a trainee at GSK in 1986 and moved through marketing, sales and business development roles within the UK, before spending two years in global commercial strategy.
In 1997, he moved to the US and worked for six years in a series of increasingly senior roles, before being appointed vice-president for respiratory marketing.
In 2004 he was appointed as vice-president and general manager, GSK Denmark, where he had overall responsibility for the pharmaceutical business. He was also an elected member of the Danish industry association board.
Returning to the UK in 2007, he was appointed vice-president, primary care, pharmaceuticals UK, and was promoted to his current position last year.
By Nicola O’Brien
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