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CONSULT’S GLOBAL REACH

Presented by Marcelo Fantoni


CONSULT IS YOUR DIRECT LINE TO THE OPINIONS AND CURRENT THINKING OF THE MOST INFLUENTIAL INDIVIDUALS ALL OVER THE WORLD, AT THE VERY HIGHEST LEVELS

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ARGENTINA N=7-10 KOL Advisors, Government, Local Level Decision Makers, Private Insurers There is no active control on Pricing / Reimbursement Who to target: •  KOL Advisors and local level decision makers •  Government stakeholders •  Private Insurers

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AUSTRALIA N=3-5 KOLs

Payers are directly involved in the pricing and reimbursement benefits of pharmaceuticals either on an advisory basis (i.e The Pharmaceutical Board Advisory Committee) or in the actual Pricing Committee and are therefore bound to confidentiality agreements and usually not allowed to take part in marketing research. This also applies to ex-Payers Who to target: •  KOLs who advice on pricing and reimbursement of pharmaceuticals and, while they don’t fit the precise definition of ‘Payers’, they are able to describe the issues and criteria used in pricing, subsidies and reimbursement as they follow the process.

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AUSTRIA N=2-3 KOLs, hospital pharmacists, formulary/drug committee members and head of departments The Austrian health insurance system is based on a social insurance system, which includes health, accident, pension as well as unemployment insurance. The underlying law is the Austrian Social Insurance Law (Allgemeines Sozialversicherungsgesetz, ASVG), which was put into effect in 1955. Who to target: •  National payer: Hauptverband Österreich •  Regional Budget Holder: Austria is “controlled” on national basis, so there are no regional differences •  Local payer: hospital’s drug committee •  Payer-advising KOLs: members of drug committee and high ranked doctors, who give advises to committee CONSULT’S GLOBAL REACH

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BELGIUM N=5 KOLs, hospital pharmacists, formulary/drug committee members and head of departments Who to target: •  RIZIV/INAMI members. •  On both a regional (province) and local level (hospitals or groups of hospitals) there are drug committees giving recommendations and guidelines as to what drugs are to be used within their organization. They tend to look at the cost effectiveness of drugs. Member of these committees can be physicians, nurses and pharmacists.   •  Expert groups when it comes to different indication areas, like diabetes, neurology etc. These expert groups are oen working in name of a physician’s association. They give guidelines and recommendations and develop treatment programs both on a regional and national level and have a good insight on how to evaluate products from a cost effective perspective. CONSULT’S GLOBAL REACH

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BRAZIL N=7-10 KOL Advisors, Government, Local Level Decision Makers, Private Insurers 100% of the populations has the right to receive health care treatment from SUS (including those who holds na HMO). Federal government establish specific rules for High Cost Programs such as: HIV, Multiple sclerosis, Rheumatoid Arthritis. 27 States and 5,561 Municipalities manage other programs, services, and hospitals Who to target: •  Decision makers within the Government at all levels •  KOL’s •  Private Insurers (Bradesco, Unimed)

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CANADA N=3-5 Hospital Pharmacy Directors, Health Canada, Ministry of Health Advisors Who to target: •  Regional stakeholders as due to the publicly funded medical system, there are no decision makers for individual hospitals. Typically, these types of purchasing or process decisions are made via committee and are for the most part done by large hospital regions and in some cases provincially / nationally adopted. •  We can also explore/ identify decision makers at the hospital formulary level.

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CHINA N=6-8 - Mix of Government and Payer advising KOLs

In China, Payers are employees of the local social insurance bureaus, which belong to a government agency. Oen, we will target the advising KOLs, who are well known in the field, or professors in medical university. The government employees are not medical personnel, and their decision making processes depend on the KOLs. It is feasible to access actual government agencies Payers Who to target: •  Evaluation Experts’ for the National Reimbursement Drug List (NRDL) for Human Resource and Social Security Bureau in individual provinces •  Typical split: National: N=1-2 Provincial: N=2-4 Local PRA decision makers: N=3-4 CONSULT’S GLOBAL REACH

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DENMARK N=4 KOLs, hospital pharmacists, formulary/drug committee members and head of departments The Danish healthcare services are primarily public and are governed by a combination of national state institutions, regions and municipalities. All three levels have democratically elected assemblies and there is a tradition of decentralization of management and planning to the regions and local municipalities Who to target: •  KOLs •  Hospital pharmacists •  Formulary/drug committee members and •  Head of departments

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FRANCE Qual: N=10-15 (mix of Payers and advisors – all levels) Quant: N=20-30 (including influencers and hospital committee members) – 75%+ IR Who to target: •  Member and advisors of: CT; CEPS; Securite Sociale/UNCAM •  Members of HAS - Economic Evaluation Group •  Committee d'achat – Heads of committees and members •  ARS Medical Directors and Budget Planner for ambulatory care •  Head of formulary committee •  Members and guidance authors of INCa

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GERMANY Qual: N=10-15 (mix of Payers and advisors – all levels) Quant: N=20-30 (including influencers and hospital committee members) – 75%+ IR Who to target: •  Member and advisors of: GBA, IQWiG, KV •  GKV - Members of SPIBU for price decision and arbitration •  Sickfunds - MDK members and advisors •  Head of formulary committees •  Bundesversicherungsamt - Members and guidance authors

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GREECE N=3-4 Payers, KOLs, Head Pharmacists, Insurance Companies

Who target: •  Institute of Pharmaceutical Research and Technology, •  National Drug Organisation •  High profiled Physicians, usually University instructors, who are very active in publishing articles and in speaking in Conferences, Congresses. •  Managers of Private Insurance Companies, •  Managers of Social Security Organizations, like I.K.A., O.A.E.E. (Insurance Institution for the Liberal Professions), •  Head Pharmacists, members of the Panhellenic Pharmaceutical Society

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INDIA N=5-7 Insurance companies and Government Officials

India is largely a self pay market, hence the concept of Payers is not very strong. Who to target: •  The Government – For employees working in the public sector and their families (this could be at the state level or national level) •  Insurance companies – For individuals who have insurance coverage through their employers (large extent) or self-purchase (very small extent) •  We have access to personnel working in the Insurance sector and they can be interviewed. •  A feasible sample size for Insurance companies would be 4-5 and for Government officials would be 3-5.

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ITALY Qual: N=10-15 (mix of Payers and advisors – all levels) Quant: N=20-30 (including influencers and hospital committee members) – 75%+ IR Who to target: •  Members or advisors of AIFA Technical committee •  Members or advisors of AIFA Economic committee •  Directors of pharmacy or members of D&TC •  Emiglia Romagna - Members of D&TC •  Hospital D&TC - Hospital pharmacists

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JAPAN N=4-5 academic KOLs, members of formulary boards

Who to target: •  Academic KOLs, who normally would have published articles, speak at conferences and lectures, and are generally leaders in their field. •  We also include KOLs who members of hospital formulary boards, or advisors to national payers. •  We are not allowed to interview government employees in this market.

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MEXICO N=7-10 KOL Advisors, Government, Local Level Decision Makers, Private Insurers The Ministry of Health is the regulatory body for all issues related to public health (institutions, policies, surveillance, budget). In addition, there are private and public health & social security institutions, with different affiliation rules and scope of provided services. Social security institutions cover almost half of the population, providing them with social security and complete health coverage at no cost. Only a very small percentage of the population has access to private health insurance, yielding a high dependency on out-of-pocket expenditure for drugs and devices. Seguro Popular (SP) is a health insurance mechanism that was aiming to achieve universal health coverage by 2012, including only a limited but growing number of covered procedures and pathologies. Who to target: •  Decision makers within the Government at all levels, KOL’s, Private Insurers CONSULT’S GLOBAL REACH

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NETHERLANDS N=5 Payer advising KOLs , Proxy PCP’s & Hospital Pharmacists

Besides the cost-effectiveness of a new drug, reimbursement will also be based on the budgetary impact of a new drug on JOZ (Jaaroverzicht Zorg: Annual National Health Care Budget), especially the impact of a new drug on the drug budget. Who to target: •  Advising KOLs •  proxy PCPs and •  Hospital pharmacists

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NORWAY N=4 Payer advising KOLs

Who to target: •  Payer advising KOLs

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POLAND N=4-5 National/Regional Payers or advisors, Heads of Departments responsible for hospital/clinic purchases Who to target: •  The Ministry of Health nominates physicians to advise payers on a regional and local level. Each Polish voivodship (county) has one nominated consultant. •  For projects investigating P&R issues we recommend KOLs, members of pharmacoeconomic associations, or HTA experts

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RUSSIA N=7 (1-2 regional payers, 2-4 local payers) Relevant respondents are officials of Healthcare ministry or Federal service on customers‘ rights protection (involved in compulsory licensing) and top managers of companies which assist producers of pharmaceuticals with licensing procedures (as the procedure of licensing is complicated the interaction with government bodies is oen outsourced to special companies.) Who to target: •  Heads of Departments responsible for hospital/ clinic purchases

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SPAIN Qual: N=10-15 (mix of Payers and advisors – all levels) Quant: N=20-30 (including influencers and hospital committee members) Who to target: •  Member of the Ministry of Health, Pricing Committee & Directorate of General pharmacy •  Comite interritorial - Members or advisors representing the communities; •  Members of HTA at community level; •  Catalonia - Members of the evaluation committee •  Hospital D&TC – Hospital Pharmacists

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SOUTH EAST ASIA N=3-5 Payers, KOL’s

•  INDONESIA N=3-5 Payers, KOL’s •  MALAYSIA N=4-5 Members of hospital formulary boards, Advisors to national payers, Academic Physicians All Health Insurance in Malaysia is either Private Insurance or Employees Benefit. There isn’t any Public coverage

•  PHILIPPINES N=4-5 Payer advising KOLs •  SINGAPORE N=4-5 Payer Advising KOL’s •  THAILAND N=5-8 Public Policy Employees from Health Insurance companies There are about 15 Health Insurance companies in Thailand

•  VIETNAM N=3-5 Payers or Health Organization Employees CONSULT’S GLOBAL REACH

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SOUTH KOREA N=3-5 Payer Advising KOL’s, Academic Physicians Who to target: •  Payer Advising KOL’s •  Academic Physicians

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SWEDEN N=4 KOLs, formulary/drug committee members and head of departments

Sweden has a population of over 9 million individuals. The Swedish healthcare system is a national health service, financed mainly through proportional taxes levied by county councils (“landsting” or “region”) and municipalities, but also through state subsidies and user charges. Who to target: •  KOLs, •  Formulary/drug committee members and •  Head of departments

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SWITZERLAND N=3-4 KOL Advisors, Heads of Dept & Pharmacists

Switzerland (population 7.8 million) is a multilingual, federal state made up of 26 states known as cantons. Health care is the responsibility of three levels of government: the federal government, the cantons and the communities. The Swiss health care system can be described as a mandatory private social health insurance system with unrestricted access to health care and free choice of providers Who to target: •  KOL Advisors •  Heads of Departments and •  Hospital Pharmacists

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TAIWAN N=3-5 KOL Advisors, Government Payers

In Taiwan, health insurance program is managed by the Bureau of National Health Insurance (BNHI) and it covers 99% of the population. Citizens pay the premium and in exchange are granted the right to access any physicians or hospitals as he/she desires Who to target: •  Government Payers •  KOL Advisors •  KOL’s

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TURKEY N=6-8 Physicians, Pharmacists and Independent Consultants to the MoH)

Ratio of obligatory public insurance is about 98% in Turkey. In addition to this, there are private and institutional (i.e. banks) insurances. Ratio of private insurance is around 20%. Reimbursement levels and contribution rate vary according to patients who are inpatient, outpatient and with a reported chronic disease. Who to target: •  Physicians, pharmacists and independent consultants, who take part in relevant commissions of the Ministry of Health, are payers. •  Please note: we cannot offer audio recording, because people who work for the MoH are not allowed to share information about pricing, reimbursement and licensing with third parties.

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UK Qual: N=10-15 (mix of Payers and advisors – all levels) Quant: N=20-30 (including influencers and hospital committee members) – 75%+IR Who to target: •  Members and advisors of NICE •  Members and advisors of SMC •  Members and advisors of AWMSG •  PCTs •  CCGs – Medical Directors •  Specialised Commissioning Bodies – Medical or Pharmaceutical Directors •  Head of formulary committees •  National budget or Access to new treatment advisors •  CMU - Members, Negotiators and Advisors CONSULT’S GLOBAL REACH

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USA Qual: N=20 Quant: N=50-70 (depending on the criteria) – 75%+ IR Who to target: •  Medicare & Medicaid - Pharmacy and medical director; •  Head of formulary committees/PBM •  Members and members of working groups of FDA •  Members and members of working groups of AHRQ •  VA - Local pharmacy directors in VA institutions

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THANK YOU Marcelo Fantoni T: +44 (0)207 749 1473 E: marcelo.fantoni@allglobalconsult.com http://www.allglobalconsult.com

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CONSULT'S GLOBAL REACH