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Insider Interview: Biosimilars to balance the books

Published on 09/07/18 at 11:43am

Jean-Yves Brault, Country Manager at Mylan UK, discusses how biosimilars are going to play an important role in driving down healthcare costs in the UK and how his company’s new product, Brabio, is faring in the market for the treatment of those with multiple sclerosis.

Brabio has been launched recently, could you tell us a little about what this will bring to the market?

As a global healthcare company, Mylan have been providing patients with access to high quality medicines for more than 55 years. The launch of Brabio, the only therapeutic alternative to Teva’s Copaxone in the UK, a product used for the treatment of multiple sclerosis, is one of the examples of how we provide access. From a legal point of view, the loss of exclusivity has happened only recently and we managed, with our external partners, to get the product approved in Europe. Alongside most of our products at Mylan, it’s an addition to our portfolio that brings greater patient access to affordable, high quality products. So, for the patients, they have more access; for the healthcare professionals, they have more options; for the NHS or payers, it creates more competition. It has the same efficacy and the same quality at a lower cost therefore freeing up resources to treat more patients and to treat them earlier in the evolution of their disease.

What work have you done directly with the NHS so far?

During the introduction of the product, in the first quarter of this year, we did communicate with the NHS, with hospitals and with patient associations to try to understand their needs for a better value product, but also what else was needed to make sure they’re aware of this option. Held two national advisory boards to understand how the NHS service will respond to our value proposition and high-quality equivalence evidence and the challenges and needs of the service arising from this.

Could you tell me a little about your interaction with the patient associations?

We collaboratively work with a broad range of Patient Association Groups (PAGs), keeping them fully informed on product and regulatory developments and supporting them in their own strategies. For example, the improved affordability of glatiramer allowed PAGs to challenge a draft review from NICE on 17 December that questioned the future ability of the NHS to fund glatiramer due to cost. With costs reducing considerably now this issue of access has disappeared and patients continue to have the choice. This is welcomed by patients and clinicians.

And, with the patient associations, we’ve started discussing the introduction of the product and to understand what the key challenges for patients living with MS are. There are about 100,000 people living in with MS in the UK; We also wanted to make sure that we could understand what work the association was doing for the patients and how we could communicate this new treatment option to these patients, but mainly to the healthcare professionals.

Multiple sclerosis is one of those diseases where patients are well aware that the treatment is extremely expensive to manage, from conversations with healthcare professionals and pharmacists, and they are involved in their own treatment. So, we wanted to make sure that we not only brought a product to the UK but also were able to complement the value of the product through additional services. Interacting with patient associations helped us to better understand what was already available, as we did not want to reinvent the wheel, but we were able to look at different educational guides. For instance, we distributed materials to help nurses to train patients to use the product and the interactions with patient associations such as the MS society and MS Trust helped us to prepare these tools before we launched the product.

How has the uptake of Brabio been since launch?

The sales of Brabio have been quite steady since we launched in January, but were slower than anticipated. When you bring a product that delivers a high-quality treatment option at a lower cost, then there will be steady switch, but there are not a lot of new patients beginning to be treated for MS. However, it’s only natural that more and more patients will be switched to Brabio but patients usually only visit the MS clinics every six months, so there’s a bit of a delay. Again, there’s a lot of complexity in the hospital that means there are more administrative issues with switching medication, even though the message is clear that it’s a better value treatment. We’re happy to see, in April and May, significant uptake in the number of patients using Brabio because the real savings that will happen for the NHS will only arrive with greater use of the medication.

What challenges does the UK market present?

I’ve been working in the UK for a little over three years now. The NHS, like most other countries that I’ve experienced, is facing the reality that the ageing population, the rate of innovation and the cost of healthcare is rising everywhere and is leading to a financial crisis. It’s now really difficult to treat all the patients with the best possible treatment without going bankrupt.

The NHS is becoming very collaborative to manage – I think there’s an acknowledgement from all stakeholders, everybody understands the need to work together to find new solutions. We’re all in this together, the goal is to better treat the UK population and this is becoming a more urgent challenge in recent years, to meet this patient need versus the budget available. The NHS seems to be handling this in the correct way, without jeopardising innovation. NICE is doing a great job at assessing the value of and the impact of products, and putting pressure on suppliers to bring them to the UK at the right price. We’re happy at Mylan, we have a lot of products on the market in the UK and they are aligned with this concept. We like to think that we’re part of the solution because you can treat the same patients, with the same quality products at a lower cost.

The drug bill for the NHS is rising at a higher rate than funding is being made available. Why are generic medications so crucial in correcting this climate?

We’re definitely not a part of the group of companies generating that rising drug bill; if anything, we’re the doing the opposite. We have more than 500 products in the UK and a good portion of those are generics. When you look at the generics market, the majority of the scripts – 70% – are generic products. Over the last decade, the use of generics has generated over £13 billion of savings every year. We’re already part of the solution by being a generics supplier and Brabio is a good example of this. We have an R&D pipeline which also has a number of biosimilars and that should help to lower costs again.

How important will biosimilars be in driving down costs?

In the UK, we have made great progress in the use of generics – it is a country with one of the highest uses of generics in the world and also the cost of generics is one of the lowest. With sustainability in mind, we need to continue this process and, in the future, biosimilars will be probably the next big thing to reduce cost. In the R&D process, to bring these products to the market, they need a lot more investment. We need companies to demonstrate efficacy and safety, it’s not just about bio-equivalence. We should see, over the next few years, companies like Mylan and others coming to the UK.

There are a lot of stakeholders in the healthcare system and many of them have some good or bad reasons for being slower in the adoption of these new options. However, I think the NHS is working harder to make them aware of the challenge and that this process is good for patients and good for the budget.

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