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EF: What does 2023 have in store for Roche in Mexico? Do you see this year as an opportunity or a challenge?
AB: Regarding opportunities, we are constantly transforming our portfolio and entering new therapeutic areas, such as ophthalmology and low-prevalence or rare diseases (Spinal Muscular Atrophy, Neuromyelitis Optica, Hemophilia, among others), which is new territory for us. Historically, Roche is a company that specializes in cancer and rheumatoid arthritis. Still, we are in a constant search to meet the unmet needs of patients, and that has led us to work on rare and neurodegenerative diseases. The organization's global revenue used to be made up of three products; today, we have fourteen. And that's excellent news for patients, but it makes the business managing situation more complex. The economic and fiscal indicators for the year look good, and inflation has started to decrease, so I don’t see great challenges in the economic sphere. The biggest challenges for 2023 continue to be access (In 2020, 35.7 million people reported a lack of access to health) and working alongside public and private stakeholders for the inclusion of therapies that impact health outcomes that matter most to the patients.
EF: Could you elaborate briefly on your footprint, operations, and portfolio? How have you adapted the portfolio to Mexican needs?
AB: It is a common misconception that the rare disease or high-cost portfolio in Latin America doesn’t have as much market as in Europe. However, in Mexico, we have been successful in our portfolio's internal transformation and in achieving an important change in access in the country. Over time the health systems have evolved, and the portfolio has grown very fast in Mexico, as in other countries. Managing costs without sacrificing quality is possible. Over 60% of the company's revenue comes from strategic and newly launched products.
EF: Roche works on bringing innovation to the region for the highest possible number of patients providing growth opportunities to the country. How do you assess access to innovation in Mexico?
AB: Roche´s strategy in Mexico and other regions is to bring value in three ways. We call it “Triple Win.”
- Value for patients: Improvements in patient health outcomes and more patients benefiting from innovative diagnostics and medicines
- Value for the Health System: Increase system capabilities through partnerships to co-create solutions with the public and private sectors.
- Value for Roche: Creating solutions that allow us to continue investing in R&D (research and development) and new technologies.
Access has different definitions and interpretations; my definition of access is when the patient has access to the proper medication at the right time. The access chain in Mexico allows that once COFEPRIS approves the product, it is immediately available on the market, but for the products to enter the public health market, they must go through a specific process, which poses different challenges to access. For example, the fragmented nature of the Mexican health demands we do separate filling for each institution, IMSS, ISSSTE, INSABI, PEMEX, etc.
Due to the fragmentation, there needs to be more uniformity in how the patients receive the drugs and services, and each institution has a different list of products. The access processes in Mexico have improved in approvals and access times, but the system still needs distribution and infrastructure. Mexico City, Monterrey, and Guadalajara have excellent infrastructure, but the hospital infrastructure is deficient in the country's south.
EF: To what do you attribute the improved access? Do you mean the system has improved, Roche has better-tailored strategies, or are your products well-received by doctors?
AB: All of the above. There has been improvement in the approval times in the different access stages, and the approved products have significantly impacted patients' lives . Roche´s philosophy is based on innovation and development and brings products and solutions to close gaps and also in unmet medical needs. On the other hand, we always seek to collaborate with the government authorities. We have done some interesting experiments with the national government and in some states to find ways of helping and strengthening the Mexican health system. We have common objectives: people's health (since primary care) and the scientific and technological strengthening of Mexico. These three factors have contributed to improved access in Mexico. There is still much to be done, but things have advanced over the last decade.
EF: In the post-pandemic world, companies have been digitally distilling what works and what doesn’t; Roche went from 3 to 14 products. How do you balance launching products into the market with the rest?
AB: My opinion on digitalization is that it was overestimated when it was considered to replace personal interactions between stakeholders, doctors, and patients. Digital is the mean, not the goal. It won't substitute human interactions; but will continue to be a critical tool in the health ecosystems for interactions and communications -no more and no less. We are far from how things were pre-pandemic; we have advanced digitally, but not to the extent that doctors prefer digital interaction with patients. We must search for the best way to improve interactions with our clients, and we have adopted a mixed model, going for both face-to-face and digital, depending on who prefers what. The voice of the customer matters, and we adapt to their wishes. Beyond digital, there are other tools, such as omnichannel and social networks, and other tools that use technology in interactions which will be critical but not unique.
Electronic health records are critical to the development of health systems. For a patient to go from one system to another today involves complex paperwork and is one of our limitations in Mexico, as in many other countries in Latin America and the world which lack EHR. Mexico´s fragmentation complicates interoperability in the health ecosystem, as all the institutions have different systems. Roche has done some experimental initiatives with some government institutions helping them implement EHR, but the real goal is for them to be national and for the entire health ecosystem.
EF: EHRs are not a matter of “if” but of “when.” Sooner or later, they will come.
AB: The US only has electronic health records due to Obama´s ACA’s Health Information Technology for Economic and Clinical Health in 2009 , and they became a priority for the United States health system. Our government knows the importance of EHR, and several public institutions, such as IMSS and SEDESA, recognize the advantages too. I know that, as I do, many public and private stakeholders refuse to lose hope of getting EHR into Mexico. It is the way to go. Digital healthcare and EHR will put the patient in charge.
EF: Mexico is strategically important to Roche from an access perspective fuelled by clinical research. Could you elaborate on your clinical research footprint and the spillover it offers?
AB: I firmly believe Mexico can become an innovation and investigation hub; it has the necessary human and technological resources to achieve it. Argentina is an incredible development example, and Mexico can go down the same road. To be more competitive, the time for approvals has improved, but surely still we need to work together to improve the approval process and we have seen openness to discuss issues and also possible solutions. About six months ago, the average approval time for a clinical trial could take up to 200 days, and we can't compete with Argentina, Brazil or even less with the US, who have long recognized how important the timely generation of quality clinical trial data is to approving new medicines. Argentina and Brazil have promulgated or modified the regulation to encourage research development through clinical trials.
After meetings with the Mexican ambassador in Washington and subsequent discussions and meetings with COFEPRIS, approval times have been reduced to 40-50 days. It can be improved even more, especially the approval consistency. With the right conditions in the country, Roche Mexico is committed to investing a billion pesos by 2025. R&D should be further strengthened in Mexico for the intrinsic benefits of research and investment and earlier contact of patients with innovation. Roche invests an enormous amount in R&D; we are the company that invests more in investigation and clinical trials in the country and we are interested in a larger participation in clinical trials.
EF: What is your pitch to headquarters to attract resources to the Mexican market?
AB: It makes a difference when we deliver on what we promise. If we want more patients, investment, and research, we must convince the HQ that the conditions are right to bring investment to Mexico, and that includes macroeconomic stability and regulatory certainty. Investments have, year after year, increased in the country, and we need the reassurance that the health systems will keep evolving and improving. Mexico has about 130 million inhabitants, of which nearly 30% don’t have access to health . Judging solely from the Mexican population, we can agree that the size of the pharmaceutical market should be bigger, but still, the huge growth opportunities for the future are obvious.
EF: Roche has a catchy slogan: “Doing now what patients need next.” What actions and decisions are you taking now that will impact Mexican healthcare five years later?
AB: To have a future, we need a present; we must believe it to be possible and deliver what we promise. We work aligned with the country authorities, COFEPRIS, and the health department to improve Mexican health systems, investment, and approval times of new therapies. And our local work nourishes and is nourished by regional and global synergies such as the Movement Health 2030. For example, we have a “Movimiento 2030” with long-term effects, the “Cancer City Initiative” in Guanajuato, and activities with the INCAN, among others. Roche has the unique advantage of having three divisions (Diagnostics, Diabetes Care, and Pharma) which allow us to accompany the entire healthcare cycle of a person, from diagnosis to disease management, with a personalized medicine approach. Diagnostics are critical to individuals' health, there begins the sustainability of the health system: With an early diagnosis and a timely referral to a specialist doctor.
We also have a very interesting outcome-based process ( short, mid, and long-term health outcomes) that allows us to be agile in a highly complex and fast-changing environment, with the patient always at the center.
EF: Could you share your possible thoughts when, in three years, you will have been in Roche, Mexico, for 15 years?
AB: I would like to be remembered for the company’s contribution to the health system and the patients. I would also like to be recognized for my work ethic; I am passionate about developing people within the company and seeing them grow. Much has happened over these last 12 years I have worked in Roche Mexico, but people don’t remember numbers and gains but achievements on a human level. My contribution to Roche and the growth of my people as a result of my leadership matters to me.