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HEALTHCARE PUBLIC RELATIONS: Moving beyond disease-specific information to include leadership, corporate values • 4 RESEARCH: Who needs patents, anyway? Montreal Neurological Institute goes open science • 13

MY TURN: Proposed changes to PMPRB could mean patients have less access to therapies • 18

Publications Mail Agreement No. 40016917

• September 30, 2017 •


n Campaign tries new tactic to attract donors, promote capabilities


By Emily Innes-Leroux,

of THE


Raising funds for Camp Liberté

In June, Galderma Canada Inc. and 75 friends and family walked to raise funds for Camp Liberté, the initiative supported by the dermatology community for children with skin disease. The walk and other fund-raising activities raised over $5,000, which was matched by Galderma, enabling four more campers to attend Camp Liberté. “Our intention was to start a grass roots initiative that would allow us as a company and those who support the dermatology community a way to unify our interests, and what better option than to support the patient. They are the ones we are all interested in helping,” said Wendy Adams, gee-em of Galderma Canada Inc. (in pink cap). (Ch Chrron oniicle Comp mpaanies photo/E to/Em mililyy Innes-Lerou ouxx)

Forecasts predict pharmas are heading into five years of steady sales growth The business of pharma

© MMXVII, All rights reserved. Chronicle I/R Ltd.

Sick Kids TV promotion focuses on fight against disease Aw a r e n e s s


typical pre-game rituals: pulling on protective gear, putting on eye black, and a team huddle. But, the ad is not about pro athletes. Rather, it is kids, parents, nurses, hospital staff, and doctors who are gearing-up for action. Doctors pull on latex gloves and secure head lamps and children adjust their prosthetics and shave their heads. The group heads to a battlefield surrounded by an army, clearly ready for a fight. A neon graphic message pops up: “Sick isn’t weak”And then, “Sick fights

n But by 2021, Canada not likely to maintain position as one of top 10 global markets


By Ian J.S. Moore



record annual sales growths between 3.2 and 3.7 per cent in each of the next five years, leading to a record sales total of $30.5-billion in 2021, according to QuintilesIMS forecasts “That [forecast] takes account of all the different factors taking place, from growth of biosimilars, new environment, patent losses, all of that [is] factored in,” company president Michael Brogan told the PharmaFocus 2021 meeting held in B ro gan Mississauga, Ont. (The event this year marked the silver anniversary of the first meeting initiated, produced and organized by industry veteran Ian Therriault 25 years ago.)

Sales of brand-name medications will account for most of the industry’s total in each of the next five years, at $20.67-billion this year and growing at a higher rate in each successive year to 3.5 per cent in 2021 from the 3.1 per cent anticipated this year. Sales in the generic segment will also jump, moving through a see-saw of growth rates through five years to a total of $6.8billion in 2021. JAPAN DROPS PRICES EVERY TWO YEARS

Brogan said global spending on drugs will also begin to increase during the next five years at a combined annual growth rate (CAGR) of 3 to 6 per cent, moving in constant US dollars to $1.39-trillion five years from $1.14-trillion this year. “Only one market was in the red, and that was Japan where they drop drug prices every three years,” Brogan said regarding the top 10 markets for global sales in 2016. “The US has come back to earth [with sales of $450.6-billion] as [the growth in

the hepatitis C market] has diminished.” Canada, he noted, managed to hold on to the 10th rank for drug spending among the top 10 global markets last year, which was led, as traditionally, by the United States. However, Canada is not likely to maintain its current position. “In 2021 we’re actually forecasting that Canada will fall out of the ‘Top Ten,’ Brogan said. “We’ll be number 11 with Spain moving up the ranks [to number 10].” The primary care segment of the Canadian market sales continued grow again last year, hitting 2.1 per cent to $17.2-billion, with specialty biologics reaching $5.4-billion (up 9.8 per cent), while sales of specialty Turn to Higher page 6à

back”And: “VS.” The Hospital for Sick Children’s (SickKids) ad, called “SickKids VS: Undeniable,” features pediatric patients in a wrestling ring, smashing a dialysis machine with a baseball bat, racing through the hospital halls on a motorcycle, sporting cartoon superhero capes, and attacking a punching bag. There are also gripping scenes of children undergoing operations by teams

Turn to SickKids page 7à

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TO P TEN SI M PLE I NVENTI O NS THAT CHAN G ED TH E WO RLD. THE WHEEL The Big One, it got everything rolling. The oldest known was discovered in Mesopotamia and dates back to 3,500 B.C.

THE PLOW By making large-scale grain production possible, it transformed human society into agrarian societies. Then came cities.

THE SAIL The simple power of the wind let us discover our world. Inventing the boat first helped, too.

STIRRUPS They made the horse an efficient, long-range mode of transportation, and a war machine that changed history.

THE PULLEY It’s tied with the lever and fulcrum for the Top 10, but Archimedes gets the credit for both; and for lifting civilization to remarkable heights.

SANITIZATION Where would we be without the lowly sewer? No city of more than 10,000 could have survived without a simple way to flush away waste. Clay sewer pipes go as far back as Babylonian times.

THE CANDLE It was a dark world until around 70,000 B.C., when hollow rocks were filled with moss, soaked with animal fat, and ignited. Candleholders from the 4th century B.C. have been found in Egypt.

THE SPEAR It started out as a sharpened stick to hunt food with. Later it led to conquering armies reshaping the world.

THE BASKET Basket weaving allowed us to gather and carry foodstuffs more easily, and survive more easily. 12,000-year-old ones have been discovered.

THE COMPASS Observing that lodestone aligns itself in a north-south direction, Chinese fortune tellers around 200 B.C. found a simple way to open the world to exploration.

Strategy • Creative • Rep Tactics • CME • Patient Adherence Programs • DTC • Advisory Boards/Consultant Meetings James Cran 416 926 2126 •

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September 30, 2017 · 3

The Chronicle of Healthcare Marketing

NOCs of Note: September 2017

Significant TTP approvals of Rxs for human use

Anti-TNF therapy 07-28 Adalimumab (humira, ABBvIe Corp.) Comments: new fill volume, subcutaneous, 80 MG/SYR

Human monoclonal antibody 07-28 secukinumab (Cosentyx, novartis) Comments: product monograph update, subcutaneous, 150 MG/ML solution and powder for solution.

Human biosynthetic 07-27 Insulin injection human biosynthetic (entuzity Kwikpen, eli Lilly Canada Inc.) Comments: subcutaneous, 500 UNIT/ML

Neurokinin 1 antagonist 07-28 Fosaprepitant dimeglumine (emend Iv, merck Canada Inc.) Comments: Addition of males to the indication for the prevention of nausea and vomiting due to treatment with moderately emtogenic chemotherapy, powder for solution, 150 MG/VIAL Antifibrinolytic agent 07-25 Tranexamic acid (Cyklokapron, pfizer Canada Inc.) Comments: Updates to inner and outer labels of the 500 mg presentation, oral

Turn to NOCs page 16à

at up to $700,000 per year, according to the A recent report from the federal Up Here National Post, although some provinces have negoparliamentary Budget Officer What’s happening in drug marketing tiated a lower cost. In finding Canadian prices are (pBO) rekindled interest among excessive, the board ordered Alexion to return a some politicians in a national portion of amounts paid, and to lower its list price immediately. The Pharmacare plan. The analysis finds Canadians could save $4 billion annually by empowering health Canada to buy all formulary drugs for company says, “We strongly disagree with the pmprB panel's deciall provinces and territories, and select more generics. The pBO recsion and we will be seeking immediate judicial review.” ommends charging patients no more than five bucks per prescription privately held PURDUE PHARMA of pickering, Ont. tapped David A. as an out-of-pocket cost, and making rxs free for seniors, the unemPidduck as prexy and CeO. he replaces Craig Landau, who says, “I ployed and others. Catch is, the feds would be on the hook for $20 have every confidence that david’s energy, commitment, skills and expebillion in drug costs each year, and, as mia rabson of the Canadian rience will enable the team at purdue pharma Canada to continue to do press explains, Ottawa “isn’t exactly jumping up and down with excitement to do it.” the right things for the patients we serve and further grow a sustainable, integrated business here in Canada.” diagnostics-maker ALERE of Waltham, mass. recently agreed to sell its two Ottawa plants to SIEMENS of Germany, after a ruling by Canadian and Us trade regulators. ABBOTT LABS is seeking to acquire Alere, as part of a shakeout in the medical device sector. The acquisition process has dragged on, following admissions from Alere that the company’s books are inaccurate and it offered payola to overseas officials. Those mea-culpas reduced Abbott’s offer to $Us5.3 billion from Us$5.8 billion. Last year, Abbott paid Us$25 billion for ST. JUDE MEDICAL and divested its optics unit to JOHNSON & JOHNSON for Us$4.3 billion. VALEANT PHARMACEUTICALS of Laval, Que. says it recently repaid more than $1 billion of debt, using proceeds from the sale of INOVA PHARMACEUTICALS, along with cash from operations. The company

aims to repay lenders $5 billion by February of next year. valeant’s latest divesture is its OBAGI MEDICAL PRODUCTS unit, which it agreed in July to sell to Chinese investors for $190 million. says val boss Joe papa: “We will remain focused on investing in our core businesses that will drive growth and where we believe we can make the biggest impact on the lives of patients.”

The patented medicine prices review Board (pmprB) recently decided ALEXION PHARMACEUTICALS has been overcharging for its biologic eculizumab (soliris.) The Tx is a monoclonal antibody for paroxysmal nocturnal hemoglobinuria (pnh), a form of anemia. The condition affects an estimated 180 Canadians. Alexion set Canadian pricing

Professional Pearls

Rapid change: The pharmaceutical market in Canada and across the world is changing faster than ever, with disruptive technologies altering how different stakeholders in health communicate with each other. At the 2016 National Pharmaceutical Congress, two speakers suggested strategies for remaining adaptive and competitive in a rapidly evolving world.

Succeeding in an exponential world 4 key points

Miron Derchanskhy, Head, LEO Innovation Lab, LEO Pharma Understanding the problem or need you are facing allows you to reframe it and approach it from a different angle. For example, if patient adherence to a medication is low, understanding the cause of that low adherence—perhaps slow progress of improvement leading to a perception of lack of efficacy—can better guide a response. Act quickly on innovative ideas. Testing the viability o a new concept should be done within 100 days. That includes three key evaluations: is there a need, can we deliver it, and is there value t the company. Co-create innovations—ideate, build, and test ideas in collaboration with the patient or end-user. Work with leadership and operation teams from outside the industry who have proven records of success. do not evaluate innovation just on outputs. Track resources dedicated to innovation, how many new concepts are generated, how many prototypes are created, and measures of efficiency like time from idea to prototype, and the development stage each idea is at.

How to get ahead of a changing market 4 key observations

Paul Petrelli, VP, Rare Disease Business, Biogen sales representative access to prescribers has fallen steadily for the last decade. The majority of doctors now search online for medication information that field reps used to provide. A poll of physicians by Google found that sales reps were least likely to be identified as their most frequent source of product information We need to find new opportunities to communicate with health providers. Traditionally we have contacted the health industry through physicians and pharmacists. A more grated approach may be valuable, building on the power of partnerships with different stakeholders. It may be worth recruiting and training reps with a broader, ‘athlete’ skillset. We could learn from the medical devices industry, where reps are not only doing sales, but customer service, adjudicating payments and transfer of services, and even helping physicians in the Or use their products. make your human and digital interactions work together. Connect on multiple channels— digital vs. human contact is not an either/or proposition. step away from ‘e-detailing’ with tablets, which does not embrace the strengths of the digital environment. embrace social media.

We transform transactional, “one-off” customer advisory boards into ongoing, online conversations to improve stakeholder engagement, speed and quality of insights shared and the costs associated with running live meetings.

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4 · September 30, 2017


Special Report

The Chronicle of Healthcare Marketing

in H ea lt hca re

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September 30, 2017 · 5

The Chronicle of Healthcare Marketing

Warner Biddle, franchise head at Genentech Corporate thinking


n The first instalment in an ongoing series that will profile exceptional leaders in the pharma community

o kick off a new series profiling exceptional leaders in Canadian healthcare marketing, rob seguin and Christine Woodley spoke with Warner Biddle of Genentech. In 2010, Biddle took the big leap, packed up his family and moved to san Francisco from Toronto to become vice-president and franchise head at Genentech. previously, he was the ophthalmic business franchise head for novartis Canada and prior to that, held a number of senior marketing and sales roles within Canada and Internationally, in europe.

B id d le

however, his transition to the Us involved learning the nuances of the large and complex American marketplace and adjusting to the differences of the American healthcare system. seven years later, we sat down with Biddle to discuss his leadership adjustment to the Us, especially his insights into defining, measuring and leading a culture that was distinct and well established. specifically, we wanted to know the reasons behind his decision to measure the active culture of the two franchises he has led since moving there—the Lucentis Ophthalmology Franchise and BioOncology skin Cancer Franchise. “If you don’t measure the culture you are leading, you really can’t tell what you’re up against,” Biddle begins. “It is important to understand what’s going on with your people, determine where to place your emphasis, guide specific actions, and to give you a better read as to which direction to take.” And then he added a thought that is sure to give new team leaders pause: “here’s the thing—culture happens anyway, whether you do anything about it or not. Getting an accurate reflection on your team’s culture gives you a lever to guide you moving forward.” since Genentech conducts regular internal employee engagement surveys every two years, we asked Biddle what additional insights his own culture measurement (completed with help from the Thrive partnership Group-rob seguin of the productive

Leadership Institute and dr. david Jamieson from environics), managed to add to what was already there. “The internal company surveys helped to measure overall engagement and red flag any obvious issues, but the Thrive partnership tools were better because they could be cus-

tomized to what we needed, specific to our team and able to get below the surface to understand root causes of our strengths and weaknesses,” Biddle says. he explains the process. “We started with the end goal— what kind of culture do we want? We had previously done some work to define our culture with

extensive input from my leadership team and members of the broader franchise,” said Biddle “We had defined our culture with specific values that were con-

sidered important for our team to attract the right kind of people and compete successfully, such as innovation, integrity, customer focus, Turn to Biddle page 8à

This is the first instalment of The ChrOnICLe OF heALThCAre mArKeTInG’s feature on exceptional culture leaders in the Pharmaceutical industry. The series was developed by Rob Seguin and Christine Woodley from The Thrive Partnership Group in conjunction with The ChrOnICLe. In this issue, they speak with Genentech’s Warner Biddle.

CCPE CLASS OF MEDALISTS: June 2016 to May 2017 AccreditaƟon (GOLD)

Rahiem El Borai


AccreditaƟon (SILVER)

Dany Riachi

Impres Pharma Inc.

AccreditaƟon (BRONZE)

Lyndsay Fairweather P. Lorena Sanchez Moali

GlaxoSmithKline Servier Canada

Biosimilars in Canada

Christopher Becevel Megan Malone Cheryl Stepanko

Purdue Pharma BGP Pharma ULC Merck


Krista Nowicki

Bayer Inc.

ConƟnuing Health EducaƟon (CHE)

CurƟs Boyechko

Eli Lilly Canada


Anthony Aversano Mélina Larocque

Associate Member Impres Pharma Inc.


Ryan Henderson

Associate Member

Engage Rx: The 3 Keys to PaƟent-Focused Growth for Pharma Professionals

Sandra Klassen-McGillis

Bayer Inc.

Evidence-Based Medicine

Nicole Cataford

NovarƟs Pharma

Field Sales Management

Nathalie Larose

Lundbeck Canada


Danielle Chouinard



MaƩhew ChisleƩ

Purdue Pharma

Healthcare In Canada

Kylie Brandon

Boehringer Ingelheim

Health Science for the Medical Technology Industry

Pranav Pandya

Associate Member


Julie Annick Desabrais


Improving PaƟent Care and Sales Performance Michael Evans with Electronic Medical Records (EMR)


Launch: Life Sciences Products

Thomasina Spybey


Managing People

Bryan Junkin MaƩea Thompson

Purdue Pharma Merck

McGill University Oncology

Meredith Smith

Ferring Inc.

Metabolic Syndrome & Diabetes

Shannon Soares

Lifescan Canada


Marilou Paradis

Sunovion PharmaceuƟcals

Persuasion Rx: How to Influence Ethically

Eric Hamel

NovarƟs Pharma

PharmaceuƟcal Market Access in Canada

MaƩea Thompson


Pharmacoeconomics (Basic)

Camille Gagnon

Associate Member


Helen Morris

Lundbeck Canada


Jonathan Habra

Lundbeck Canada


Erick Gasca



BrigiƩe Bellemarre

Eli Lilly (CDA)

Women’s Health

Nicole Skibo

Purdue Pharma

EducaƟon, AccreditaƟon, Professional Ethics

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6 · September 30, 2017

The Chronicle of Healthcare Marketing

Higher number of oncology products introduced worldwide last year continued from page 1

non-biologics slipped slightly (-1.3 per cent) to $3.0-billion. “don’t believe the negative 1.3 per cent [figure],” Brogan said. “That’s entirely driven by the hepatitis C results.” Last year sales of hep C therapies tumbled to $687-million from the 2015 total of $859-million, a steep drop. Brogan noted

that in each year since 2014, the number one medication, in terms of market value, was a hep C product, and although 27 new hCv brands were introduced last year, the segment’s ride up the sales scale had ended by dec. 31. “It’s likely 2016 is the last year we see that phenomenon,” Brogan said. Launches of new agents for

“I think we’re going to see a

fundamental shift

in the market from one drug-one tumour type to one drug-many tumour types.” —Michael Brogan

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oncology, respiratory therapy and diabetes treatment trailed hep C introductions in 2016.


Year-to-year comparisons of sales within the private drug plan segment are noteworthy, Brogan said. hep C medications accounted for six per cent of the 2013 to 2014 total drug cost increase, and 6.8 per cent during the following 12month period. In 2015 to 2016 there was a drop of 51.3 per cent in hCv sales while the number of claimants leaped almost 40 per cent. The cost-per-claimant was lower that year by 19.4 per cent. Year-over-year, 2015 to 2016 private drug plan costs for biologics to treat auto-immune disorders were recorded at 14.9 per cent along with an additional 10.6 per cent number of claimants. The respective number in the diabetes segment were 14.8 per cent and 4.8 per cent. Again last year Johnson & Johnson was the sales leader, reaching $2.9-billion (when consumer product sales are included). Abbvie at $0.86-billion completed the top 10 rank listing. Four of these 10 sales leaders had lower moving annual total (mAT) growth rates: Gilead, pfizer/hospira, novartis and the generic combination of Teva/ Cobalt/Actavis. Fifteen years after its launch in 2001, and with a leading market share of 4 per cent, remicade was the medication (and biologic) used most often by Canadian patients in 2016. six other biologics were also among the 15 leading brands in this category. Brogan noted there are more there are almost 300 potential medications at preclinical to registration stages in the pharmaceutical pipeline, ranging from six for dengue fever and 45 for Alzheimer’s disease. “Thirty per cent of this number are biologics and that’s been a fairly big number for a lot of years,” Brogan revealed. STRONG CANCER TX PIPELINE

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Globally, a higher number of new oncology products were introduced last year, a reflection of the increase of medications in this single pipeline, which has expanded by 63% in the past decade. new medications for breast, nonsmall cell lung cancer (nsCLC), prostate and acute myloblastic lymphphoma (AmL) are the most numerous at phase II or higher in the pipeline now. “I think we’re going to see a fundamental shift in the market from one drug-one tumour type to one drug-many tumour types,” Brogan said, anticipating pharma market trends in the months and years ahead.

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The Chronicle of Healthcare Marketing

Sick Kids tries different approach to extend brand, reach new donors continued from page 1

of physicians. Throughout the two minute video, a list of conditions to defeat are flashed across the screen including kidney failure, cystic fibrosis, autism, and cancer. DISEASE AS ‘FIGHT’

Last fall, the sickKids Foundation launched this “sickKids vs:” campaign (developed by the agency Cossette Communication Inc.) and has continued to roll out ads that build on this theme. The second ad in the series was more emotionally charged, capturing the story of Grace Bowen who lost her life to cancer. The spot also focuses on the scientists and researchers who are working on continuing “her fight” to improve the survival rate from 80 to 100 per cent. The most recent commercial was launched on sept. 26, 2017, titled “sickKids vs: Join Us.” This new instalment features Canadian actor ryan reynolds. The campaign has been popular and the initial ad was viewed more than 700,000 times to date on YouTube, was featured as’s Ad of the day (Oct. 16, 2016), and has made international news.

Ignazi. “And the great thing about those kinds of brands is they really stand for something and they are very empowering and exciting and you can tell

that story in many different ways. “nike does not just do one type of commercial, they do very impactful and powerful ones, but they do also soft and emotional ones, with a lot of power as well.” Ignazi said the neon vs sign has become an iconic representation of sickKids and that people are responding to those two letters.

Helping you grow despite the obstacles.


“What I see [this ad] doing differently from other healthcare advertising is that it does not try to trigger guilt with the messaging, it is triggering . . . something participatory and D a v i s on inspiring,” said Lori davison, vee-pee of brand strategy and communications at sickKids Foundation. davison said the objective of the campaign was to attract a new audience of donors. The typical donor is primarily female and 45 years of age and older, she said. They also wanted to focus on the performance aspect of the institution. “We needed to take [a] quantum leap and we could not do that by saying the same things we have said before in a slightly different way—we needed to jolt people into action,” said peter Ignazi, chief creative officer at Cossette. “Lori talked about performance and that gave us the idea that maybe we should start treating the brand not as a charity brand, but talk about it in terms of being a performance brand like nike or Under Armour,” said



“every great idea has to be simple, it needs to be understood quickly and be easily shared. especially nowadays, simplicity in ideas is key,” he said. The campaign, according to davison, has led to more male donors and also an increase in donors between the ages of 25 and 44 years of age. “so it does seem to be striking a cord with a different audience,” she said.

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8 · September 30, 2017

The Chronicle of Healthcare Marketing

Revised rules and regs drag PMPRB into 21st century Government agencies

n Head honcho says making prescription drugs more affordable is a federal, provincial and territorial priority



s OrIGInALLY InTended

almost 30 years ago—and as currently framed—the patented medicine prices review Board is not working, executive director douglas Clark told the recent market Access summit in Toronto. “prices are high and r&d is low, actually below where it was in the mid-’80s,” he told the recent market Access summit in Toronto. In 2016, he said, the agency finds itself hobbled by a number of problems, difficulties that may be overcome once current consultations on guidelines are completed, reformed and the pmprB framework is “modernized.” Consultations on the pmprB were first recommended in the Liberal government’s recent election platform, eventually leading to a mandate Letter from the Office of The prime minister to dr. Jane philpott, federal minister of health. philpott was shifted to a different federal department during a summer cabinet shuffle. According to Clark, current problems facing the pmprB include the fact that the United states—one of seven comparator countries—has the highest drug prices in the world and these prices tend to skew any price comparison totals. In recent OeCd calculations of drug price ratios in 31

countries last year, Canada (ratio: 1.0) was behind the United states (2.57) and mexico (1.07) in the cost of patented medications, but above the median ratio of 0.78. “If we could get our ratio down to Cl ark the median [Canada] could save over three billion dollars annually,” Clark said. US PRICES AFFECT THE GROUP

Within pmprB comparator countries, Canadian prices are below the median of drug prices for the seven countries, but only because Us prices are so high. If Us prices were removed from the calculations, Canada would rise to 50 per cent above the median price for the six other countries. At a price ratio of 1 Canada was also above the median (0.73) for generic prices in comparator countries, according to the pmprB’s fourth quarter calculations last year. Last year Canadian spent 56.6 per cent of the medication costs on patented drugs and 24.5 per cent on generic agents. They spent the remainder on other segments (16.5 per cent) or non-patented single-source medications. public plan expenditures were also on the increase in 2015. The spends for all drugs (12.2 per

cent), patented agents (19.1 per cent) multi-source generics (2.5 per cent) and unpatented singlesource agents (33.2 per cent) were higher, too. public plans also doubled to 104.9 per cent their expenditures on patented high cost (>$10,000) medications, biologics (9.8 per cent) and other patented medications (24.6 per cent). The pmprB system today is slanted toward rewarding therapeutic benefit for Canadian patients, not the abuse of excess pricing, Clark said. “Our only absolute ceiling for existing drugs is the highest international price,” Clark noted. “and ‘me-too’ drugs can be priced at the top of a domestic therapeutic class. It is based on publically available list prices, which are increasingly divorced from the true price net of confidential rebates and discounts.” COSTS IN CANADA ARE HIGH

healthcare costs in Canada are going up as they are in other counties, he added, and taxpayers are finding it difficult to match their available dollars with the costs of using new health technologies. “In addition to relatively high utilization, Canada pays among the highest prices in the world for patented and generic drugs. And a surge in high-cost drugs is driving public drug plan spending into double digit growth and is accounting for a disproportionate share of total pharmaceutical

spending in Canada.” making prescription drugs more affordable, he said, is a priority shared by the federal, provincial and territorial governments. “right now there’s a lot of pressure to address affordability issues in Canada.” Clark reminded his audience of the pmprB’s history. established in 1987, the agency was an attempt by the federal government to balance its competing industrial and social policy objectives by strengthening patent protection as one way to encourage the r&d efforts of drug manufacturers. DOUBLE R&D EFFORTS?

The legislation, Bill C-22, considered the pmprB as a “consumer protection pillar” that would ensure a pharma holding a novel medication patent did not exploit its new proprietary status. A second goal was to double r&d efforts in Canada to 10 per cent of pharma revenues and at the same time hold Canadian prices in line with those in seven other countries: U.K., switzerland,

sweden, Germany, France and Italy (aka “The pmprB-7”). “The pmprB is part of a complex, multi-layered, regulatory and reimbursement system.” Clark said, referring to a system that stretches from basic r&d and patent through various regulatory stages that include health Canada, the pmprB itself, private drug plans, CAdTh, pCOdr, pCpA and reimbursement. Clark said a bilingual discussion paper is slated for publication this fall, followed by public policy hearings in the winter and spring of next year and finally publication of the proposed new guidelines the next autumn. Canada is not the only country grappling with drug prices that do not seem to stop rising, and the others have introduced measures to address the problem. “All stakeholders, including industry, stand to win from a price regulator that contributes to the long-term sustainability of Canada’s healthcare system,” Clark said.

Biddle: ‘Don’t tackle too much’

teamwork and collaboration, etc. With the Thrive partnership process, we could then shape a measurement tool to be specific for our team and our values.” so, after working with Thrive to measure the culture of his new teams, we wanted to know: what actions did Biddle take to shift the franchise culture, and what have been the results? Biddle has some advice. “It is really important, first of all, to strike the right balance. You need to let everyone know that you heard their feedback and you are not trying to rationalize any results. At the same time, it is important not to overreact to the results you receive. many organizations look at the results and confuse action with a strategic response. It’s vital to be strategic and to socialize the results.” —continued from page 5


Takeda christens new Canadian HQ

In late may, Takeda Canada Inc., the Canadian sales and marketing arm of Takeda pharmaceutical Company Limited opened its new hQ in Oakville, Ont. says Chatrick paul, gee-em of Takeda Canada: “We chose to stay in Oakville because of our history here and because for many on our team, Oakville is considered home. The new Takeda Canada office fosters collaboration and team work—essential attributes to achieving our goal of becoming the leading company in our areas of focus among patients, physicians and other stakeholders.” Takeda has a presence in over 70 countries. Cutting the ceremonial ribbon are (l-r) Giles platford, prexy, Takeda europe & Canada, paul, and Oakville mayor rob Burton. (Ch (Chrron onicl iclee Comp ompaanie iess photo/L oto/Lyynn Bradshaw)

At Genentech, this meant sharing the results with the teams involved and then allowing the feedback to add colour in shaping the action plan. Biddle also advises prioritizing the results, as the process can be overwhelming, especially if there is entropy (negative feedback). With Biddle’s franchises, the results were interesting. “With Lucentis, the results showed a gap with accountability of cross-functional teams. While this was a major concern, it was important not to take immediate action, but instead we had to do a deeper dive to see how to enhance and bring people along,” he explains. his other franchise, skin Oncology, was different. “The skin team showed high engagement, but the irony is that they wanted more.” This is an interesting phenomenon of cultural measurement—the higher the engagement scores, the more a group is likely to crave and clamour for more communications, more feedback, and more ways to increase engagement. so, after two cultural measurement processes spanning several years, what advice does Warner Biddle have to share with those contemplating a similar path? “I’d say it’s important not to tackle too much. If you try to do too much, too quickly, you’ll confuse being busy with being effective. I’ve seen leaders form a bunch of committees, running around with knee jerk reactions, and they lose traction. “It’s better to keep it tight, keep it a self-motivating thing and ensure that people are with you as you go through it. Ultimately, it comes back to the ‘why’ question—you do it because even great engagement and great cultures need work, because they are constantly evolving. You can never take your team’s culture for granted.”

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Robert Lavoie In memoriam


he pharma business has always had its share of various recognizable types. Through the years, however, there was never a category capable of defining Robert Lavoie of Montreal. Bob Lavoie was not like everybody else. He created and built a worldwide brand, Ombrelle sunscreen, along with a portfolio of products and a sustainable national business, on his own, using scant capital. He began Dermtek Pharmaceuticals with little more than four wheels and a home office — along with his instincts, persistence, and the item that proved to be his ultimate resource, which was the stuff in his heart. He worked hard, played hard, and did not apologize for loving life. He possessed the imposing physical form and the shaved pate of a TV wrestler, and the appraising, benevolent eyes of a starving artist. He approached the creation of medicines with an aesthetic sensibility. Efficacy should always be a given, but if a product didn’t look right or feel right, or failed to live up to his vision, he would scrap the lot, take the financial hit, and begin again. He could never explain his style of perfectionism to Bay Street, but the good news was that as an independent business owner, he never had to. He was, appropriately for the founder of a dermatology company, comfortable in his skin. When he once came across an ad for a hair restoration product that featured a bald father and his balding son under the headline, “Now You Don’t Have to Look Like Your Father,” he shook his head sadly. “What,” he wanted to know, “is wrong with looking like your father?” His father met his mother in Bermuda during the 1940s, where he travelled to take an immersion course in English. The student, Jean-Louis Lavoie, was Quebecois; the teacher, Joan Marie Smith, was Irish. They married. Bob entered the world via Quebec City in 1946. JeanLouis was a tireless entrepreneur, which in post-war Canada meant you sold things door-to-door. One of the products he represented was a plastic overlay meant to be placed over a monochrome television screen, that purported to convert your black-and-white set into living colour. They cost a couple of bucks apiece, and JeanLouis could barely keep up with the orders. There could only have been some sort of FrancoHibernian alchemy in the Lavoie household. The five kids each became accomplished. Brenda is an acclaimed graphic designer; Jack writes, sings, records and performs music while running a large landscapearchitecture business; Paul makes documentary films and founded an award-winning multinational ad agency; Michele Cherbaka made a career in nursing and helping others. The Quebec City of Bob’s adolescence in the ‘50s and early ‘60s was characterized by Elvis on the radio, sock hops, and the genial prolonged boredom that marked the era. To pass the time, groups of lads would square off in the parks on summer weekends, emulating the “rumbles” observed in the movies and in the popular magazines. The usual tribal divisions were in place, and the goons from St. Patrick’s, the English high school, would enact scenes from West Side Story against the toughs from the rival École, who were happy to reciprocate the attention. Bob attended St. Pat’s, with his buddies Gerry Hickey and Dennis O’Dowd, and many good times were had across the cultural divide, taunting and punching, and receiving insultes et coups de poing. Much later, Bob would wonder why he raised fists against the kids from the francophone high schools, observing, “I’m French myself.” He let the memory of cousin-whomping-cousin linger for another minute. “It’s crazy,” he concluded. “It doesn’t make any sense.” That became one of his signature catch-phrases, and he’d use it to summarize current developments in commerce, medicine, gastronomy, music, and politics, all with the same verdict. It’s crazy; it doesn’t make any sense. Bob’s first job was selling newspaper ads for the Quebec City Chronicle-Telegraph. Out somewhere trying to hustle up business, he came across a man who drove a very cool car. Bob thought to ask the man what he did for a living that enabled him to own a vehicle such as that. The man said, “Why, son, I’m a pharmaceutical representative,” and Bob suddenly saw what his future would look like. He applied for a job at Westwood Pharmaceuticals of Belleville, Ont. and Buffalo, N.Y., which became the dermatology division of Bristol-Myers Squibb. They hired him, provided a not-especially-cool car and a heavy

n Founder of Canadian dermatologics company remembered as astute business builder, benefactor, friend

President, International League of Dermatological Societies, and Head, Department of Dermatology and Skin Science at the University of British Columbia, Vancouver

ONE OF THE THINGS I will always remember about Bob was the postcards he would send out, and the Christmas cards for Reversa. Bob’s son Michel looks exactly like Bob, but a much younger version. I remember when Bob sent out [the cards] and they showed a picture of himself, and it showed a picture of Michel, dressed exactly the same way. Showing ‘the effects of Reversa.’ Then when Bob had a grandson, he [remade] that card, saying ‘the strength of Reversa continues.’ And it showed Bob, and it showed Michel, and it showed the grandson who was also bald. To be able to give everyone a chuckle and a laugh—this was promoting the product in the best possible light. It was a great talent and a great skill. Associate Professor of Medicine at Dalhousie University and Co-director of the Chronic Wound Care Clinic at the QEII Hospital in Halifax

HE HAD A LOT of interpersonal skills that he developed over the years. [Bob] became friends with every dermatologist in Canada. I mean it sounds like fun, but it is a lot of work. Creating relationships was his forte. A lot of people said Bob was lucky. I would say the harder he worked the luckier he got. He put in a lot of time, weekends, evenings, he was constantly out there with the people.

, Chairman, Valeo Pharma Management Team

, Dermatologist, Women’s College Hospital, General Medical Dermatology & Alopecia Clinic, Toronto

I KNEW BOB from high school. And we have been friends since our teens so we have had some great times together and I am sorry to see him gone. He was a great guy who was lots of fun. His motto was carpe diem. Seize the day. He did for most of his life, I think. He had a great time and enjoyed life. Always saw a good side to every situation. He was very open, loyal, and a great friend. Montreal businessman and lifetime friend

HE WAS A DERMATOLOGY GUY, and a product salesman. He knew the best way to do that was to go directly to the dermatologists and talk to them, and to listen to them. And he did. It started becoming clear in the early ’90s that [dermatologists] needed a good sunscreen product that patients would actually use. Bob kept hearing this and started to think about it. Dr. Stuart Maddin [of Vancouver] had become a good friend of Bob’s and he had come across this new ingredient [Parsol 1789] and said: “Bob, you should work on this. Try and bring that into a formulation.” One thing led to another, and not only did [Bob] develop the product, but the brand, the idea for the [Ombrelle] brand. It was his own idea. He was a visionary. , Senior Partner at McCarthy Tétrault, Montreal HE WORKED HARD for dermatology in areas other than his own company which has become very successful. He was instrumental in the Canadian Dermatology Foundation. Helping set it up, along with others of course. And [there were] various other charities. I know he was very good about that. , Dermatologist and past Clinical Professor in the Department of Dermatology and Skin Science, University of British Columbia, Vancouver.

sample bag, and put him on the road to detail dermatologists. He became a top salesman and a familiar figure in the specialty across the country. Seven years later, Louis and Sylvia Vogel invited him to join TransCanaderm, a Canadian startup in dermatology that licensed products from U.S. and European suppliers. Bob honed his skills, and company revenues soared. Time passed and once again he developed a seven-year itch, and began thinking about launching a company that might develop and market its own line of original Canada-created skincare products. That idea would become Dermtek Pharmaceuticals. The company was born out of the rumpus room in his Pierrefonds home in 1986. He worked his tail off. He’d set off down an icecovered Highway 401, from Montreal to Windsor, Ontario, to the accompaniment of Peter Gzowski droning on the CBC’s AM-radio stations, with Sebcur T samples in the trunk, and a bag of grapes and plums as his seat-mate. He didn’t mind the solitude, and quite enjoyed the fruit. “It keeps you alert and energized during the drive. You’ve got to try it,” he would proselytize. Some key dermatologists encouraged Bob in his mission. A group of west coast physicians, led by Drs. Stuart Maddin and David I. McLean, thought the world could use a better sunscreen, and believed that an agent known as avobenzone would be useful against a broad range of sun wavelengths. European regulators approved the Parsol 1789 version of the compound in 1973, but the U.S. FDA would drag its heels for the following 15 years. Bob took advantage of the lull to create a Parsol 1789 formulation he trademarked as “Ombrelle.”

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Bob’s brother and founder of TAXI Advertising and Design

I THINK BOB WAS very well known within the dermatologic community as someone who was highly innovative, and who had a good ear for the needs of Canadian dermatologists and patients and the types of products that were needed to help patients. I think he realized that he himself was probably not going to become the equivalent of a big pharma, but at the same time I think he understood that big pharma is not going to address all the needs we have for our patients, particularly in some of the smaller markets or the smaller products. [These are] some of the niche products that we need to help our patients but that just do not have enough volume to attract the interest of some of the larger pharmaceutical companies. Bob was very good at fulfilling that important need in dermatology. And I think he did it on a very human scale, in the sense that he really took the time to learn about dermatologists in Canada—learn what their needs are and get to know them on a professional level. And in many cases on a personal level, too. By doing that he was really able to understand what the needs were, and came up with some really unique products that were very helpful. I use many of these products on my patients. And I think the other thing that is very noteworthy about Bob is he created one of the few Canadian companies that created a product [Ombrelle] that went global. , Professor Emeritus, Department of Dermatology and Skin Science, University of British Columbia, Vancouver

Brenda Lavoie designed the distinctive branding and packaging. It became the first-to-market designer sunblock, and created an entire category. David McLean recalls: “Yes, the formulation was good. The marketing was better. Brilliant package. Great outreach.” The outreach part was pure Bob. He would turn up at random outdoor events in a decorated Range Rover, with his son Michel and his son’s friends by his side, and they would pass out product samples to an amused public. Today, this practice is known as “pop up” or guerrilla marketing, and there are graduate school courses taught in the discipline. But Bob was an early adopter, if not an inventor, of these methods, which occurred to him because he thought they might be effective, also because they seemed like fun. (Two more frequently-heard Bob exultations: “How fun is that?” “What fun!”) If he was an Artist by temperament, and a Businessman by practical instinct, Bob’s third calling was Merry Prankster, ever in search of the legendary lost mine of joy. He discovered it at the North Lake Fish and Game Club, established in 1896 somewhere near Pointe-AuChêne, Que. He found it again in his Nuns’ Island penthouse, and he hit the motherlode of fun in the Laurentians town of St-Sauveur, where he purchased and restored a mountaintop Modernist home that eventually became the centre of a family compound. He sold Ombrelle to L’Oreal in 1997, for what was presumed to be a lot of money. The transaction changed Bob’s circumstances, but it didn’t change Bob. The deal intensified what was already an inclination toward generosity, and he thought nothing of handing over use of his cars or condo to anyone who expressed an interest. His wardrobe got a little

YOU NEVER SAW HIM without him greeting you with a big smile. I had known him way back to when I was a resident. He obviously branched out and became very successful, probably beyond anyone’s wildest dreams. He was always just a very personable, friendly, wonderful guy. He never changed. I think everyone was pretty shocked [about Bob’s passing]. Bob is the kind of guy for whom people use the expression ‘larger than life.’ Yes, he was a very tall man, but it was his personality—his real, engaging personality. , Consultant Dermatologist, Royal Columbian Hospital, New Westminster, B.C., and Clinical Assistant Professor, Department of Dermatology and Skin Science, University of British Columbia, Vancouver

[BOB] HAS SPONSORED the [Canadian Dermatology Association] meeting during each of these 30 past years, and [his] company also gave to the Canadian Dermatology Foundation yearly . . . Something that is really outstanding was the fact that he was present and always willing to help develop supports and services, and contributions for our specialty. Certainly, he was an honoured partner and a great friend. He always had a good sense of humour, camaraderie, and I think he was appreciated by all of us. Clinical Associate Professor, Université of Montreal and CHU Sainte-Justine, Department of Pediatrics, Dermatology Division

[BOB] WAS ALWAYS a listener. He was always interested in advice you had to give. That is the first thing, and that is an important factor, because I think that is what helped him develop Ombrelle [sunscreen] . . . I would say that he was an innovator, he was somebody who saw opportunities and went with them. As well, he was a bit of a visionary because he clearly saw the need for a [UVA blocker], which did not exist in North America . . . Coming from a small firm, he was able to modify the product on the fly, in a way, because he could talk to physicians, get their opinions, and then tweak [the product] accordingly. Clinical Professor of Dermatology at the Department of Dermatology and Skin Science and Director of Pacific Dermaesthetics, Vancouver and former national director of the Canadian Dermatology Association’s Sun Awareness and Skin Cancer Prevention Program.

flashier. He spent some time with the Nuns’ Island celebrity dentist, Dr. Elliot Mechanic. A particular low-point for Bob was after Jean-Louis died. He met a friend for a drink at the West Island Holiday Inn. He hadn’t shaved, was exhausted, and he looked terrible. Then, abruptly, the mechanism that triggered the fun function kicked in. “Let’s go up to St-Sauveur, I’ll make dinner,” he suggested. His friend had some colleagues in tow, and he had promised to provide them with a meal. Bob’s solution was, “We’ll bring them along.” So, the quickly assembled quartet shot up the Autoroute 15 at dusk. One hour later, Bob welcomed the strangers to his home and led a tour of the grounds. He began preparing supper: a fresh fish recipe he had learned from Dr. Wayne Gulliver of St. John’s, Nfld., paired with a few favorites from his wine-cellar. His mood brightened. Give Bob the opportunity to be generous, and he would grab it and run with it, and nothing made him happier. Last summer, he married his soulmate, the love of his life, Dr. Suzanne Gagnon, near the big house in StSauveur. They were surrounded by their blended and extended families, including Suzanne’s mother, and Bob’s two closest high school friends, Dennis and Gerry, and their wives. It rained throughout the ceremony, making everyone draw even closer. The music summed up the occasion: C’est si bon. Non, je ne regrette rien. A few months earlier, he had received the extremely rare Award of Honour from the Canadian Dermatology Association, in Saskatoon, which filled him with pride and emotion. Michel was excelling at his expanded role at Dermtek, and Bob’s daughter, Marie-Claude, was thinking about returning to the business after several years as a stay-at-home mom. Bob had just celebrated his 70th birthday, and (once again befitting the founder of a company that makes anti-aging products), he could have passed for being 15 years younger. Lately, Bob had allowed himself a bit of reflection on what it all meant. Dr. Maddin mentioned Ombrelle in his 2015 book on dermatologic discoveries, and he gave Bob credit for popularizing a product that has protected millions of people from sun exposure, and has surely prevented casualties. Bob revered Dr. Maddin, kept his photo displayed in his home, and the words meant far more than just the obvious validation. He seemed to hold dear his family and his friendships even more recently. He spoke regularly of his grandchildren, and was pleased with a postcard campaign he devised that featured himself, and Michel, and Michel’s newborn son Brandon, all sharing the hereditary Lavoie grin and glabrous dome. Always affectionate, he now greeted both the females and males in his circle with ardent kisses. It was as if he woke up one morning in 2016 and it dawned on him that he had created two things he’d never counted on: a legacy, and a legend. Bob died suddenly in his aerie, high atop Nuns’ Island, late in the evening on Friday, June 17, 2017. He had celebrated his 71st birthday a few days before. He spent the day chatting on the phone with friends, driving his Tesla, managing his business, and making plans. He was going to pick up his mother-in-law, Jeanne-D’arc Voyer, and drive her to St-Sauveur. Later that week he planned to be off to Fredericton, to attend his gazillionth meeting of the Canadian Dermatology Association. After that, to his cherished North Lake, where he had invited his friends Wayne and Mitch and their wives to unwind, and maybe catch a few fish. His absence was felt during the CDA meeting. He always stood out during the receptions: the pro-wrestler’s body encased in an immaculate suit, and those kind pale eyes. Middle-aged doctors, who knew Bob since residency, learned the news and began to cry. This happened again and again. Some will insist the pharma business should owe nothing to personalities. They will argue that the life sciences should only be about formulae and modes of action contained in product monographs — and never about the women or men who make or market the cures. Bob Lavoie might have disagreed, but he was aware that he started out with a natural advantage: all that stuff in his heart that made him different and set him apart. He invented some medicines and he made some money selling them, but he knew all about another thing that doesn’t have a DIN number, never gets included in formularies, doesn’t involve a listing fee, and never comes with an expiry date. That would be love, an item you can only give away. It’s crazy, is what Bob always used to say. It doesn’t make any sense.

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12 · September 30, 2017

The Chronicle of Healthcare Marketing

This is what private health plans expect from pharma Pa y e r s

n Maximum allowable cost provision gives green light to insurers to substitute lowest cost therapy


By Ian J.S. Moore,

for THE



underway within the private health plan sector, as it changes from a transactional product listing perspective to a strategic approach. That’s a

movement that will affect individual plan members, sponsors and pharmas, according to a healthcare strategist and consultant. “It’s really important to understand these really important customers and think about how

we are approaching them,” suzanne Lepage told a QuintilesIms pharmaFocus 2020 meeting in mississauga, Ont. “There is only one customer in the private insurance industry, and that’s the plan sponsor. pretty much all other suppliers

are influencers and or suppliers. It’s a very competitive market.” Lepage operates suzanne Lepage Consulting Inc. in Kitchener, Ont. CALL IT THE HEP C HANGOVER

The rocket-like rise in hepatitis C virus medication sales in Canada

to $838-million from $76-million between 2013 and 2015 has prompted all private payers to increase their scrutiny and oversight of the pharma drug pipeline and their new drug submissions as insurance companies and plan sponsors recover from this “hep C hangover” “nobody is immune,” Lepage said of this current trend among private payers. “It is not all just about biologic drugs or the specialty drugs. everybody in this room and every new molecule that is coming to market is going to have increased scrutiny.” Another significant trend among private payers, she noted, is their switch to the case management of individual drug claims as they attempt to L e page put a lid on rising costs while still remaining competitive with other insurers. “Case management can lead to therapeutic substitution. And it is a big threat because your drug may be listed on a private plan but the patient still gets switched,” Lepage said. preferred provider pharmacy networks are another trend facing these private payers. pharmacists who work in the preferred provider pharmacy network can also act as case managers and offer their services to plan sponsors as a costsaving option. “We are seeing an increased focus on prior authorization,” Lepage said regarding another notable trend that might affect a pharma’s sales. That six-page prior authorization claim form will take additional time and cost more for an insurer to review and process. MAXIMUM ALLOWABLE COST

more and more private drug programs are also attempting to integrate with provincial patientassisted programs, Lepage noted. “If there is some coverage that is available through government programs and that offers some financial relief, why not take advantage of it?” Current private payer programs may also include a maximum allowable cost (mAC) condition, which allows the payer to limit its reimbursement to the lowest cost available using a suitable alternative medication. “more and more this is being touted as a way of managing costs. It’s something that is growTurn to Private page 14à

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14 · September 30, 2017

The Chronicle of Healthcare Marketing

PR in healthcare moving beyond disease-specific information continued from page 4

pr activities like media relations. “The digital spend will be increasing over traditional pr,” Levine`said, but notes traditional media is still very much an important component of healthcare pr. The spotlight on chronic diseases has underlined the concentration on compliance to therapy for the long-term. “It is fine to promote a product and a disease state, but if the patient will not stick with your medication, then it will all be for nought,” added Levine. TRANSPARENCY SEEN AS GOAL

Apart from aiming to decrease the image of being overly promotional, pharma firms are striving to be as transparent as possible, both within and outside the workplace, said Tisch. “They want to communicate about things that are critical to their reputation like the quality of their leadership, how they govern themselves ethically in the marketplace, and fairness and transparency in their workplace,” he said. GsK Canada posts on its website, for example, the core and project funding that it provides to patient groups and what that funding represents in terms of annual revenue for a given patient group. And too, GsK has abandoned its practice of paying healthcare professionals to speak to other prescribers. SHIFT FROM DISEASE FOCUS

Clients of healthcare pr practitioners are responding to the overall trend of taking a more holistic approach to health and wellness, observed Judy Lewis, exec vee-pee of Toronto-based strategic Objectives. “marketers were more interested in the past in focusing on an individual disease state or marketing their individual drugs,” said Lewis. “There has been a seismic shift in consumer interests in health and wellness, and an appreciation for the importance

of whole body health and its potential impacts on a disease state, and that’s why they are looking for a more holistic approach.” Organizations that would not have in the past become


ChrOnICLe OF heALThCAre mArKeTInG. “The fact that a mental wellness program is geared to young women and that we are discussing [mental health] in children is new,” Lewis said.

Taking PR directly to physicians

she explained that such initiatives raise awareness among young girls, as well as their parents, about the need to get past the stigma and address mental health and wellness with healthcare professionals.

Psoriasis simulation designed to help physicians better relate to patients with the disease

number of dermatologists who attended the Canadian Dermatology Association (CDA) annual conference this year in Fredericton had parts of their bodies painted as part of campaign to help them better understand the perspectives and emotions experienced by their patients living with psoriasis. The body painting was done by performance artist Natalie Fletcher—who has psoriasis—and she believes an awareness campaign that literally puts the dermatologists in their patients’ shoes will help capture the public’s attention. “Novartis is committed to helping Canadians with psoriasis overcome the stigma, psychological and social issues that too often accompany the pain and other symptoms of the condition,” said Janice Murray, president of Novartis Pharmaceuticals Canada Inc, in a press release. “Dermatologists see first-hand the emotional and physical burden psoriasis places on their patients. We are very proud to be working in collaboration with the CDA, who represents dermatologists across the country, to highlight these realities through art.” Dr. Julie Powell, the president of the CDA and a Montreal-based dermatologist, had her torso completely painted as part of the project with flowers on her upper chest and red blotches across her abdomen and arms representing large plaques. “It was an original idea to get the doctors involved,” said Dr. Powell. “We see our patients’ distress with this disease and it was a way to maybe bring more awareness to the public doing this in an. . . unusual way. It is something that is quite striking.” She said walking around with her body painted cannot be compared to the emotions of her patients but that she did feel a sense of “embarrassment” that her patients might encounter. Dr. Powell's patients have told her that the condition affects their social relationships and they are stigmatized because other people think D r. Pow e ll they have a contagious disease. Many of her pediatric patients have been bullied and they tell her they have many insecurities. She wants clinicians to be aware of newer treatment options for psoriasis, to be aware that these patients have quality of life challenges, and for Canadians to understand that the condition is not contagious. “I was interested [in participating] because I am aware that patients with psoriasis have a significant emotional impact and stigmatization impact from their disease,” said Dr. Jan Dutz, a Vancouver-based dermatologist who participated in the campaign. “This is one way of at least increasing awareness of that.” “For us, it is easy to wash [the paint] off and be done with it,” said Dr. Dutz. “If you have the disease it is completely the opposite situation, you are stuck with it. We Dr. D utz can show the disease and display it for our purposes, communications, [and] awareness, but patients actually have this and have no way of getting rid of it. They take the disease with them every moment of the day when they interact with people.” The project was filmed by Novartis as part of a public service announcement to raise awareness of the condition and highlight the emotional and physical impact of psoriasis. —Emily Innes-Leroux

Private health plans developing new strategies, expectations of pharma —continued from page 12

involved with healthcare issues now do. The Girl Guides of Canada, as an example, developed a unique program which supports mental health advocacy for young girls, Lewis noted during an interview with The

ing and growing and something you need to be aware of,” Lepage said. step therapy as prescribed by a physician, she added, can be automated and used by the insurance company’s claims auditor. This therapeutic option can be implemented as a stand-alone, or as part of a prior authorization or case management program. managed formularies are another trend insurance companies favour today. most of these programs differ, Lepage said, and most plan sponsors and advisors do not necessarily have the expertise to evaluate and offer advice about various plans. Typically, a managed formulary has two tiers, one that includes formulary drugs reimbursed at 100 per cent

and all other drugs reimbursed at a lower 60 per cent amount. A new role has arisen within this sector of the healthcare industry, Lepage said, which is known as pharmaceutical relations. A product Listing Agreement (pLA) is the goal of most pharmas, and that objective can be time-consuming. “The justification of this [pharmaceutical relations] person’s existence is more than likely to deliver results in terms of cost savings, better prediction of rates, and potentially, of pLAs.” THE CAUTIOUS APPROACH TO COVERAGE OF A THERAPY

Although it is not a new phenomenon, the “Wait and Watch” stance when a new medication is introduced is also trending among insurance companies. It is easier for them to decline coverage of a new therapy before deciding about how they will “handle” it within its different policies and many programs. The manulife drug/Watch program is an example of

this current trend. “The Canadian insurance industry, the Canadian Life and health Insurance Association, has actively been lobbying to be part of the pan-Canadian pharmaceutical Alliance process,” Lepage said of product listing agreements, “but competition law does not allow them to do so. “meanwhile they are individually pursuing pLAs with the pharmaceutical industry.” Lepage advised pharmas to hold continuous reviews of their drug pipeline content with private payers, providing as much information as possible during discussions and before notice of Compliance submissions. “[private payers] are actively sourcing information— things like pricing and clinical data—that is available internationally, in the media and in the public domain. “They’re gathering a file on your product, and if you’re not at the table they’re going to rely solely on this information. That can work to your disadvantage.”

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Open science advocated by Montreal institution continued from page 13

cule that a human can take with low toxicity, long half-life, good absorption, and that gets into the [central nervous system]?” The open science system is being designed in such a way that it will always be less expensive for an outside party to utilize The neuro’s research than to duplicate it on their own, he said. “And the data will be made available to everybody, so [research] will go faster.” The open science format can also eliminate the need to allocate the resources, time, and manpower that can be tied up in the process of negotiating material transfer agreements with companies or research institutions, dr. rouleau said. Agreements are created to protect the opportunity to make money, but which are rarely profitable in practice. The type of research The neuro conducts, such as identifying biomarkers and developing assays and disease models, is rarely profitable in itself, he said. MORE CLINICAL TRIALS COMING

The neuro is also expanding its capacity to carry out phase I clinical trials. “Trials start where there are relationships,” said dr. rouleau. If a pharmaceutical company wanted to develop and test a molecule against a therapeutic target that had been identified by The neuro, “We would hope that they would choose us as the site, or have one of our researchers be the pI [principal investigator] for the study.” The first two areas of study that the open science initiative will focus on will be parkinson’s disease and ALs, said dr. rouleau. “We have a good ALs clinic which actually picks up a good portion of the ALs cases in the province. It has approximately 350 patients they follow,” he said. The neuro is also the primary home of the Quebec parkinson’s network. “We have a clinic here that follows roughly 1,000 patients and is linked to another 3,000 through the Quebec parkinson’s network.” Later fields of interest will include ms, brain tumours, and other forms of dementia, he said. “What we would really like is for this to be repeated elsewhere. We have been approached by a couple of institutions that are thinking of going the same direction as us,” said dr. rouleau. “I think a measure of success would be if 10 other institutions adopted—maybe not the same thing as us, but something very similar to what we did.”

Bayshore HealthCare makes Deloitte list

In March, Bayshore HealthCare, based in Mississauga, Ont., was named to Deloitte’s list of the Best Managed Companies in Canada for the 11th year in a row. According to a press release, the Best Managed designation recognizes Canadianowned and managed businesses for their demonstration of strategy, capability, and commitment to achieving sustainable growth. Bayshore also received the highest designation, Platinum status, for the fifth consecutive year. “The consistent recognition as a Best Managed Company

is a result of our 11,000 dedicated employees across 60 branches and 45 clinics in Canada,” said Stuart Cottrelle, president of Bayshore HealthCare in the press release. “Employees are empowered to provide input into innovation, process or service concepts regardless of their particular role or location, truly creating a platform of inclusiveness. That’s what puts us among the best in the country.” Bayshore has made an increased investment in digital health and innovation, patient self-management solutions and patient engagement tools, and continued expansion of its community health services. The program is sponsored by Deloitte, CIBC, Canadian Business, Smith School of Business and MacKay CEO Forums.

Social networking and healthcare

How to pick the best channels for customer touchpoints

When CreATInG A KeY OpInIOn LeAder enGAGemenT pLAn, you must first start by determining all the possible product and market factors that are impacting brand performance and isolating the top three to five key issues that are preventing you from capturing 100 per cent market share. It requires a process of stepping out of the day-to-day and going back to basics. Why is your brand where it is today? One must also isolate the knowledge and insight gaps surrounding your brand. What is keeping you up at night? What questions still keep you scratching your head? next, you must decide which customers in your stakeholder universe will be key in helping you to achieve your success metrics for the issues and objectives you have laid out. It also requires you to identify the core data sources that should be leveraged for that particular target audience and how that information should be gathered, framed and presented to them. Once you have mapped out your overall key opinion leader strategy and engagement plan outlining the issues to be solved, the metrics for success, the customers you will be targeting and the data you will be engaging them with, the next step is to determine what channels will be best suited to help gather the insights you are seeking. At Impetus digital, we provide three specific methods to assist our clients in engaging with their customers. The three touchpoint modalities we employ are: in-person meetings, web meetings and asynchronous online assignments.

In-person meetings In-person meetings are the tried and tested way in which most pharmaceutical companies have engaged with advisors and steering committee members. This is the historical norm and brand plans and budgets have always included the costs associated with this traditional communication modality. In fact, in most companies, when somebody mentions the word “advisory board”, they are usually conjuring up an image of a group of customers gathered around a board table in a meeting room for anywhere between four to eight hours. There are many reasons why brands choose to engage their customers using in-person meetings. First, pharmaceutical companies have their commercial roots firmly embedded in the large sales force model. historically, when physicians were the key decision makers, sales reps were utilized to inform and educate prescribers about their product’s benefits for their patients. In-person sales calls were effective and helped propel product sales from launch throughout the product’s full life cycle before loss of exclusivity. The connection was made that relationships, connections and the trust that ensued were keys in getting products prescribed. This belief carried forward in all other marketing strategies, even if they were considered “non-personal” promotional activities. The number one priority for companies has been to build relationships with customers becaise they see it as the only effective way to truly connect. In addition, consultancy meetings have traditionally been used as an alternative “sales” channel in which brand ideas, plans and data are

discussed in corporate board rooms and simply brought in front of boards for “buy-in”. In today’s environment, connecting in person has become increasingly difficult. Legislation, compliance and institutional regulations and disclosure requirements have deterred healthcare providers in meeting with sales reps and attending pharmaceutical sponsored events and programs. In addition, because time pressed physicians are expected to produce more with less time in order to meet financial targets, key opinion leaders have fewer hours available to consult with companies. In the uber-competitive pharmaceutical marketplace where hundreds of products are vying for attention with minimal points of differentiation, physicians are being asked to consult on more boards than time will allow. They can no longer fly from city to city to attend half- or full-day meetings. In addition, pharmaceutical companies are slashing traditional marketing budgets. In a more risk averse environment where compliance rules, promotional efforts are thwarted and greater levels of transparency are expected, less money is being funnelled into sales and marketing. manufacturers are also struggling to maintain growth targets and address shareholder expectations with dwindling pipelines and less than stellar revenue projections for products that are not first in class. pharma marketers, however, are still being asked to engage in the same activities but are now faced with the dilemma of targeting a much broader and more complex stakeholder base. With new decision-makers thrown into the mix such as allied healthcare providers, hospital administrators, payers and patients, the question on how to meet with everyone in person to drive the business becomes even more pervasive. Although in-person consultancy meetings can be excellent in terms of relationship building and capturing advisors’ initial impressions on data and new information, they are not the best from an overall engagement metric standpoint. On average, over the past six years that we have planned in-person meetings, our experience has shown that from the original roster of invitees, only about 60 per cent are able to attend live meetings. As a result, marketers are often compelled to invite other second tier advisors in order to bolster their meeting attendee numbers. In addition, since most medical professionals are considered “analyticals” and require time to process new information, presenting brand new data during an in-person meeting can often result in knee-jerk reactions from the attendees. Based on team dynamics and the psychology of body language and personality types, verbose advisors can often outshine the more introspective attendees who may not choose to speak up as often, if at all. As a result, in-person meetings may not always result in the most comprehensive inclusion of everyone’s opinions on specific issues, no matter how well meetings are facilitated. NEXT: Web meetings Natalie Yeadon is Managing Director, IMPETUS Healthcare. Impetus is an Online

Customer Advisory Board expert, offering comprehensive B2B Online Customer Advisory Board solutions. Impetus helps drive brand direction and strategies through the retrieval of timely insights with customer executives and key opinion leaders through a series of project managed online touchpoints. To learn more about using the Impetus InSite platform for your next advisory board, contact Natalie at or call 416–992–8557.

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16· September 30, 2017

The Chronicle of Healthcare Marketing tent uniformity testing analytical method, oral tablet, metformin HCL 500 MG/TAB/canagliflozin 50 MG/TAB; metformin HCL 850 MG/TAB/canagliflozin 50 MG/TAB; metformin HCL 1000 MG/TAB/canagliflozin 50 MG/TAB; metformin HCL 500 MG/TAB/canagliflozin 150 MG/TAB; metformin HCL 850 MG/TAB/canagliflozin 150 MG/TAB; metformin HCL 1000 MG/TAB/canagliflozin 150 MG/TAB

NOCs of Note: September 2017

Significant TPP approvals of Rxs for human use —continued from page 3

tablet, 500 MG/TAB; IV liquid 100 MG/ML

Inhaled corticosteroid and bronchodilator 07-24 Fluticasone furoate/vilanterol (Breo ellipta, GlaxosmithKline Inc.) Comments: Update to product monograph, fluticasone furoate 100 MCG/BLD and vilanterol 25 MCG/BLD, inhalation

Microtubule inhibitor 07-21 eribulin mesylate (halaven,

eisai Limited) Comments: An alternate manufacturing process for drug substance and an alternative drug product manufacturing facility involved in the production and testing of the sterile drug product, Iv solution, 0.5 MG/ML

Synthetic vitamin D analog 07-24 Calcitriol (rocaltrol, hoffmann La roche Limited) Comments: Changes to the innner foil labels, oral capsule, 0.25 MCG/CAP, 0.5


Antiretroviral agent 07-21 darunavir ethanolate (prezista, Janssen Inc.) Comments: Change in the drug product manufacturing process and change in the composition of an immediate release dosage form, oral tablet, 600 MG/TAB

Oral hypoglycemics 07-27 metformin hCL/canagliflozin (Invokamet, Janssen Inc.) Comments: An alternate con-

Antisense therapy 06-29 nusinersen sodium (spinraza, Biogen Canada Inc.) Comments: Intrethecal, solution, 2.4 MG/ML

Human monoclonal antibody 06-28


Golimumab (simponi, Janssen Inc.) Comments: product monograph update, solution, subcutaneous, 50 MG/0.5ML, 100 MG/ML

Human monoclonal antibody 06-28 Golimumab (simponi Iv, Janssen Inc.) Comments: product monograph update, solution, intraveonus, 50 MG/4ML

Protein kinase inhibitor 06-22 Afatinib (Giotrif, Boehringer Ingelheim (Canada)) Comments: Update to the product monograph with 1) supporting safety and efficacy data from phase IIB clinical trials ; 2) new post-market adverse drug reaction; and 3) information regarding renal impairment study, tablet, oral, 20 MG/TAB, 30 MG/TAB, 40 MG/TAB

PARP inhibitor 06-22 Olaparib (Lynparza, AstraZeneca Canada Inc.) Comments: Update the product monograph with regard to drug interactions and dosing recommendation for patients with renal and hepatic impairment, capsule, oral, 50 MG/CAP Opiod 06-21 Buprenorphine hydrochloride (Belbuca, paladin Labs Inc.) Comments: film, soluble, buccal, 75 MCG/DOSE, 150 MCG/DOSE, 300 MCG/DOSE, 450 MCG/DOSE, 600 MCG/DOSE, 750 MCG/DOSE, 900 MCG/DOSE

Antiretroviral therapy 06-21 raltegravir potassium (Isentress hd, merck Canada Inc.) Comments: new 600 mGh film coated oral tablet, 600 MG/TAB

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Monoclonal antibody 06-16 Ipilimumab (Yervoy, Bristolmyers squibb Canada) Comments: Fullfillment of post-approval conditions, liquid, Iv, 5 MG/ML

Glucagon-like peptide-1 (GLP1) receptor agonists 06-15 Liraglutide (victoza, novo nordisk Canada Inc.) Comments: expansion of indication and updates to the product monograph. victoza is indicated for once daily administration for the treatment of adults with type 2 diabetes to improve glycemic control in combination with diet and exercise in patients for whom metformin is inappropriate due to contraindication or intolerance, solution, subcutaneous, 6 MG/ML

Antiviral 06-15 Ledipasvir/sofosbuvir (harvoni, Gilead sciences Canada) Comments: extension of shelf life to 48 months, tablet, oral, ledipasvir 90 MG/TAB/sofosbuvir 400 MG/TAB

Human monoclonal antibody 06-12 Ustekinumab (stelara, Janssen) Comments: Labelling updates, solution, subcutaneous, 90 MG/ML, 45 MG/0.5ML Human monoclonal antibody 06-12 Ustekinumab (stelara Iv, Janssen) Comments: Labelling updates, solution, Iv, 5 MG/ML

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Proposed changes to PMPRB could reduce access to therapies, stifle research —continued from page 18

whether the drug is administered orally or intravenously) or wider societal issues related to lost productivity in its recommendations for which insurers of employmentbased plans may be willing to pay a higher price. more generally, the requirement for manufacturers to submit cost-effectiveness analyses of their drugs from other countries to the pmprB is duplicative work for companies and government, which will cost taxpayers more money and further restrict patient access to essential treatments. Another proposed misstep is the modifications in the list of countries used for comparing drug prices. The changes include the addition of Japan and south Korea and the removal of the Us and switzerland. While replacing high pharmaceutical-cost countries with lower-cost countries will artificially bring down the calculated “average,” it essentially brushes off all responsibility of ensuring that pharmaceutical companies will continue to invest in researching new and innovative drugs and asks the populations of high pharmaceutical-cost countries to subsidize our health system. not only does this threaten research and development investment in the Canadian pharmaceutical industry, but it also risks a downward spiral in global research on new and innovative treatments and cures.

manufacturers in order to spur investment in research and development (r&d) in Canada.” It's troubling that while the pmprB was created to help facilitate greater pharmaceutical r&d, the proposed changes are certain to undermine such investment and potentially reduce patient access to new life-saving treatments.

Dr. Nigel Rawson is a senior fellow and Bacchus Barua is a senior economist at the Fraser Institute. © 2017 Distributed by Troy Media.


Up Here

What’s happening in the world of drug

the industry lobby, says two new companies have become members: AKCEA THERAPEUTICS CANADA and


based affiliate of a massachusetts biotech that is in turn linked to IONIS PHARMACEUTICALS of California. The company focuses on lipid disorders. Jared Rhimes is gee-em. Ipsen, based in paris, has Canadian operations located in mississauga, Ont., where it employs 50 workers. The company develops

of note could come from dhaka, Bangladesh. marketing Generics outfit

Cns, Ca and endocrinology Txs, and just tapped Paul Reider as country manager. says Pamela Fralick, Innovative medicines Canada prexy: “[Akcea and Ipsen] are joining us at a crucial time when we are committed to establishing a refreshed dialogue with all healthcare stakeholders on ways to ensure Canadians get the medicines they need when they need them, while ensuring system sustainability and economic growth for the country.” Canada’s next pharma newcomer


thalmic Tx olopatadine is the first rx from Bangladesh to launch here. The company says it has filed for a second product and anticipates nOC in 2018. According to managing director Nazmul Hassan: “entry into the Canadian pharmaceutical market, following the successful launch of our first product in the Us last year, is a significant step forward in strengthening our presence in north America.”



Ottawa wants to “protect” Canadians from high drug prices by changing pmprB rules to increase “affordability, accessibility and appropriate use of prescription drugs.” But a requirement for more cost-effectiveness analyses or ever-increasing demands for huge price reductions will not reduce the lack of affordable drug access many patients face. They are more likely to produce delayed access, or eliminate access, as pharmaceutical manufacturers decide that Canadian marketing requirements are overly burdensome and instead launch their drugs in other countries with less red tape. delay or denial of access to life-saving drugs is a potential death sentence, while a lack of access to drugs that can change a life of misery into good health is cruel punishment. Canadian patients need drug insurance schemes that provide access to the right drugs at the right time without cost constraints. more pmprB bureaucracy that results in delay or denial of access will harm patients. According to its annual report, “the pmprB was created in 1987 as the consumer protection ‘pillar’ of Bill C-22, legislation which also strengthened the patent rights of pharmaceutical

Visit to see why. Each month, 90% of physicians read printed medical publications, and 57% visit medical publication websites1. The Canadian Association of Medical Publishers (CAMP) recognizes the impact and importance of reaching physicians effectively. To learn more go to:

Studies + Resources sections @

1. 2013 PMB Medical Media Study

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The Chronicle of Healthcare Marketing


Dr. Hoskins and the T-word

RANSPARENCY” IS A FAMILIAR WORD THAT SHOULD BE COMMONLY understood. However, the intended meaning behind transparency can sometimes be far from transparent—in the sense that invoking the term can be used as a ploy to distract or deflect, thereby allowing the continuation of practices cloaked in obscurity. In the field of linguistics, such usage is known as an “auto-antonym” or a “Janus phrase.” So it is that the Government of Ontario, facing an election next year and trailing in the polls, just introduced the idea of new legislation aimed at compelling therapy-makers to publicly disclose most financial exchanges with healthcare professionals. These would include honoraria, speaker and advisory board fees, travel grants, and likely even coffee and pastry receipts from working sessions. Dr. Eric Hoskins, the province’s health minister, says: “It’s important to have this level of transparency and accountability. It creates even more confidence in our health-care system.” A spokesman for his federal counterpart chimes in that Ottawa “will continue to look at ways to increase openness and transparency for Canadians.” Brian Lewis, head of the device-makers’ lobby adds that his group “supports Ontario’s objectives towards greater transparency in health care.” Dr. Hoskins’ hijacking of the T-word came, regrettably, during a week when several individuals linked to his party were tied up in a courtroom, defending their alleged criminal act of intentionally destroying records relating to a 2011 mishap that cost taxpayers $1.1 billion. (The trial continues as this issue of The Chronicle goes to press.) As an added curiosity, the Ontario government a few weeks earlier announced the conclusion of a process aimed at determining the best choice to operate a retailing monopoly for the sale of recreational cannabis products to the public. Queen’s Park considered submissions from established pharmacy organizations, along with proposals from other interested groups. Then they calculated the lucrative potential of running the sole legal marijuana enterprise serving a population of 14 million. And what do September 30, 2017 • you think PUBLISHER they decided? Mitchell Shannon The government deliberEDITORIAL DIRECTOR MANAGER, OPERATIONS ated (not all R. Allan Ryan Cathy Dusome that transparSENIOR EDITOR SALES & MARKETING ently), and Lynn Bradshaw Peggy Ahearn ASSOCIATE EDITORS COMPTROLLER then awarded John Evans Rose Arciero Emily Innes-Leroux

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THE CHRONICLE OF HEALTHCARE MARKETING welcomes contributions from readers. In particular, we’d like to know what’s going on at your company, or organization, and you are especially welcome to keep us informed about new developments, new appointments, and new practices at your shop. If you’re submitting an article, opinion piece, press release, or letter to the editor for consideration, please bear in mind that we select material for publication from a large volume of submitted material, and that we may not be able to publish your submission in a specific issue (or at all) due to space constraints and other considerations. Our policies are: All material submitted to THE CHRONICLE becomes the property of Chronicle Information Resources Ltd., and is subject to the company’s usual editorial procedures; We will not consider for publication any material that has been simultaneously sent to other publications; Only original material or information will be considered; Payment at our established freelance rates will be offered upon publication for feature articles and for the following departments: What Lies Ahead: Original articles of approximately 500 to 700 words dealing with trends that shape the healthcare industry; and My Turn: Opinion pieces of approximately 500 to 700 words, offering original commentary on issues facing the healthcare industry. Please refer inquiries to: Editor, The Chronicle of Healthcare Marketing, 555 Burnhamthorpe Rd., Suite 306, Toronto, Ont. M9C 2Y3 Canada. Fax 416.352.6199, E-mail:

the prize to… itself! These coinciding incidents serve to illustrate that the meaning of transparency may be regarded in different ways, at least in the minds of Dr. Hoskins and his cabinet colleagues. They appear to believe that plenty is required for thee, but semi-transparency should suffice for me. In truth, the proposal for a registry of financial relationships between HCPs and Big Pharma is far from that big a deal. In the US—hardly a beacon of progressive healthcare policy—legislation known as the Physician Payments Sunshine Act has been in place since 2010, and it is this law that Dr. Hoskins apparently wishes to replicate. The proposed implementation date in Ontario would follow the Americans by a full decade, if anyone is keeping score. (Several EU nations, Australia and Japan have introduced similar registries along the way.) It’s possible to argue against the need for such measures, but why bother? In an age characterized by the existence of Wikileaks and the hacker culture, it’s safest to assume that all manner of information will eventually be disclosed, come what may. In 2017 and beyond, the only prevention against having indefensible practices come to light is not to engage in indefensible practices in the first place. But why listen to us? Just ask J. Michael Pearson if he still thinks Philidor was a good idea. That is not to revisit the old philosophical discussion of whether a senior physician will change his or her prescribing behaviour if presented with a $10 Tim Horton’s gift card as a gratuity. In all likelihood, they will not, and maintaining a public database of how many $10 gift cards Dr. Hypothetical received from Brandi-the-drug-rep is not that much of a meaningful contribution toward public discourse on the critical subject of health policy and the emerging need for care rationing. However, it should not take long for anyone to suspect that Dr. Hoskins and his colleagues and counterparts fear the political risk of encouraging an open conversation about the real-world challenges faced by the province’s health system. Among such threats must be included the long tradition of ineptitude and worse in Queen’s Park. (For more as applied to the life sciences, Google the term “MaRS Bailout”.) Hence, this pre-election distraction: Hey, let’s all get transparent! You go first. It may be understandable in a cynical political context, but what is especially galling about Dr. Hoskins’ announcement is his typical self-congratulatory ministerial flourish, tinged with the inevitable implied blaming of the private sector. Introducing this scheme now is not at all about finagling his government’s slim reelection chances; goodness, no. Rather, he says, “it’s about empowering patients and giving them tools and information so that they can make better, more informed decisions about their own healthcare.” Really, doctor? Because if you’re truly a fan of transparency, we’ve got to disclose our opinion that the floating of this plan at this juncture represents a megadose of pharmaceutical-grade hypocrisy. Opinions expressed are solely the editorial judgment of this publication, and do not represent any other views. Rebuttals and comments are invited. Write to:

Proposed changes could reduce access to therapies


By Dr. Nigel Rawson and Bacchus Barua,




hile well-intentioned, changes to Patented Medicine Prices Review Board (PMPRB) could stop companies from launching new drugs. In a speech in May, federal Health Minister Jane Philpott talked about rising prescription drug prices and announced the launch of consultations on proposed changes to the PMPRB designed “to protect Canadians from excessive drug prices.” The proposed changes may be well-intentioned, but could delay access to medications in Canada or deter companies from launching new drugs. This would significantly impact the ability of health-care providers to treat patients with new, innovative and potentially life-transforming medicines. Many new drugs, in particular biologics and genetic therapies, are more expensive and more effective than the traditional “small-molecule” drugs that public and private insurers historically cover, which raises additional concerns about affordability. Consequently, insurers want pharmaceutical companies to demonstrate the value of their drugs before considering them for coverage. All stakeholders, including patients, would like to see drugs that are cost-effective. However, what’s sometimes forgotten is that the only thing worse than an expensive drug is an inaccessible one. For 30 years, the PMPRB, an independent federal organization, has sought to strike a balance between ensuring Canadian prices for patented medicines are not excessive while recognizing the importance of pharmaceutical innovation by allowing companies to recoup the immense cost of researching, developing and testing new lifesaving and life-improving treatments. The PMPRB does this by comparing the price that a company proposes to charge for a new drug in Canada with prices in seven comparator countries (France, Germany, Italy, Sweden, Switzerland, the United Kingdom and the United States) and with the Canadian prices of similar, older drugs. NEW ANALYSIS REQUIREMENTS WOULD EFFECTIVELY DUPLICATE CADTH SUBMISSIONS

Now, the federal government wants to require pharmaceutical companies to submit pharmacoeconomic (costeffectiveness) analyses of their drugs in the health-care settings of Canada and other countries to the PMPRB to demonstrate the value of their products. Currently, companies submit these assessments, based on Canadian health-care data and prices, to the Canadian Agency for Drugs and Technologies in Health (CADTH) for recommendations regarding reimbursement in public drug insurance plans. While CADTH does not set prices, it frequently recommends price reductions to improve the cost-effectiveness of a drug. Importantly, CADTH’s negative drug reimbursement recommendation rate is close to 50 per cent, which could have serious consequences for patient access. So even if the PMPRB simply used the analysis submitted to CADTH, it would be inappropriate for it to set a price based solely on a cost-effectiveness analysis of the public insurance market because CADTH’s analyses do not account for patient preferences (such as Turn to Proposed changes to PMPRB, page 17à

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2017 FACULTY • Warner Biddle, Genentech • Brian Bloom, Bloom Burton • Peter Brenders, Sanofi Genzyme Canada • Brian Canestraro, Intercept Pharma Canada • Andrew Casey, BIOTECanada • Patrick Cashman, Take Care • Tiana DiMichele, Impres Pharma Inc. • Pamela Fralick, Innovative Medicine Canada • Karl Frank, Bayshore Specialty Rx • James Hall, Aralez Pharmaceutical • Brian Hilberdink, Novo Nordisk Canada Inc. • Robin Hunter, Mallinckrodt Pharmaceuticals • David Jamieson, Environics • Joe Knott, The Pangaea Group • Sara Leclerc, ViiV Healthcare Canada • Kevin Leshuk, Celgene Canada • John Leombruno, McKesson Canada • Eileen McMahon, Torys LLP • Ronnie Miller, Hoffmann-La Roche Limited • Paul Petrelli, Jazz Pharmaceuticals • Allison Rosenthal, Otsuka Canada Pharmaceutical • Mitch Shannon, Chronicle Companies 2017 Platinum Sponsors • Bayshore Specialty Rx • Chronicle Companies • Impres Pharma • McKesson • The Pangaea Group • The Thrive Partnership Group

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The Chronicle of Healthcare Marketing Sept. 20, 2017  
The Chronicle of Healthcare Marketing Sept. 20, 2017