Read the Conversation

EF: What is on your agenda for this running year?  

RC: Novartis is celebrating 90 years of presence in Brazil. This moment holds special significance for us as we recognize this milestone as a testament to our enduring commitment. These 90 years represent our maturity as a company, enabling us to impact the healthcare system profoundly.  

Our focus revolves around five distinct and well-defined therapeutic areas: Oncology, Hematology, Cardiovascular, Immunology, and Neurology and three main technological platforms Gene Therapy, Cell Therapy and Radioligand Therapy Over the past few years, this strategic emphasis has allowed us to delve deeply into these domains, fostering meaningful discussions and progress. 

Our current situation in the country is very positive. Our sales have consistently performed well, breaking records last year, with further achievements projected for this year. We have successfully adapted and thrived in navigating the company's global transformation. However, we also recognize the importance of actively assuming a role in ensuring the sustainability of the healthcare system. Innovation is a critical driver in any industry, particularly healthcare. While innovation often comes with a cost, we, as an industry, are responsible for seeking long-term sustainability for the system. Consequently, a paradigm shift is necessary when considering effective solutions for this endeavor.  

We have taken on a pivotal role in innovative medicines and beyond. Novartis has proudly been at the forefront, introducing cell therapy and gene therapy to Brazil, and we aim to pioneer radioligand therapies on a significant scale. Yet, our primary focus extends beyond simply bringing innovation; it lies in ensuring that these advancements reach the patients who need them. Innovation in access becomes the pivotal element. To this end, we actively seek value-based healthcare discussions and explore risk-sharing agreements. Notably, last year, we achieved a major milestone by becoming the first company to establish a risk-sharing agreement with Brazil's public healthcare system (SUS) for gene therapy.  

Our goal remains to reach as many patients as possible. Last year's accomplishments were just the beginning as we strive for continued growth.  

EF: Can you elaborate on your strategy to effectively address access in a country as diverse as Brazil? 

RC: Our primary focus lies in introducing innovation and ensuring its widespread accessibility. However, finding a straightforward solution to this complex issue proves challenging. With Brazil's population exceeding 200 million, approximately 75% rely on the public healthcare system, while the other 25% navigate the private system, which presents its own set of obstacles. Nevertheless, we remain committed to addressing these challenges and aligning our solutions with the system's needs. 

We must consider the system's pain points when introducing innovations, ensuring they add tangible value for the healthcare system and patients. We rely on real-world evidence and locally relevant data to achieve this, empowering us to make informed management decisions. Embracing the digital realm also plays a pivotal role, enabling us to harness data and transform it into valuable insights. 

Moreover, we are exploring alternative models, such as risk-sharing agreements and value-based healthcare metrics. This internal evolution aims to break down traditional barriers that have governed our industry for decades, enabling us to chart a new path forward. Ultimately, our overarching goal is to embed the concept of access into the fabric of our organization. In Brazil, we emphasize the collective responsibility to ensure medicines reach as many patients as possible. We strive to fulfill our mission and deliver meaningful impact by adopting this mindset. 

EF: What strategic collaborations have contributed to the significant growth in your patient numbers and expanded reach in recent years? 

RC: Partnerships play a pivotal role in driving substantial improvements in healthcare over time, though their execution can be challenging, as the healthcare landscape in Brazil involves various stakeholders with divergent incentives. We have actively pursued partnerships across private, public, and hybrid sectors, exploring diverse commercial models, value-based healthcare hypotheses, and collaborative initiatives with specific Health Maintenance Organizations (HMOs) and hospitals. Engaging with governments and key states in Brazil has also yielded promising outcomes. 

To illustrate with an example; cardiovascular diseases represent Brazil's leading cause of death. Given Novartis' extensive experience in cardiology spanning several decades, we have a wide range of products catering to primary and secondary care. When launching a new product, the typical industry approach involves identifying unmet medical needs and positioning the product accordingly. However, in the case of Inclisiran, a registered cholesterol-fighting medication we sought to bridge the gap in Brazil's primary and secondary care systems. This required a collaborative solution. Instead of pursuing isolated discussions with private or public entities, we partnered with Conasems—an influential government entity responsible for improving primary care across all municipalities in Brazil. Recognizing that addressing access issues begins at the municipal level, our partnership with Conasems focuses on practical solutions rather than negotiations. By aligning our efforts with Conasems, we ensure that our impact is felt directly where it matters most. This partnership, which has already spanned a year and a half, exemplifies an innovative approach to creating meaningful change. 

Furthermore, we have collaborated with other entities, such as the independent organization Novartis Foundation, which established a cardiology treatment program in partnership with the municipality of Sao Paulo. Our next frontier involves exploring private-public partnerships by engaging with HMOs, hospitals, and prominent healthcare groups in Brazil. Co-creation and collaboration are key as we work towards our common goal. 

We have organized impactful workshops and other out-of-the-box initiatives, which extend beyond product launches and highlight our commitment to the entire healthcare ecosystem. Ultimately, we firmly believe that healthcare is a collective endeavor and strive to ensure its accessibility and impact for everyone. 

Our approach recognizes that there is no single solution to transform the healthcare system; it requires a series of carefully orchestrated efforts. Instead of seeking instant success, we understand the importance of testing and refining various ideas through incremental steps. We can make a meaningful and sustainable impact by starting with small-scale initiatives, assessing their effectiveness, and then expanding upon successful outcomes.  

Whether it involves discussions on healthcare funding, value-based projects in specific hospitals, or forging partnerships in primary care, each endeavor represents a unique avenue through which we can contribute significantly to advancing healthcare in Brazil. 

EF: How do you see precision medicine advancing in Brazil? And how can we utilize emerging markets and innovations to maximize value creation? 

RC: The challenges faced by a country like Brazil are significant. The healthcare system is strained and fragmented, and Brazil's population is aging rapidly. Given these circumstances, the importance of precision medicine becomes paramount. Effectively delivering tailored treatments to individuals is crucial, as it ensures both efficacy and enables innovation. One notable example is our partnership with the government on gene therapy, where we have defined precise criteria based on scientific evidence, data, and target populations. This approach stands for precision medicine, where payment structures are based on patients' responses and outcomes. Implementing this model involves payment frameworks, cash flow management, patient monitoring, and identification processes. 

Nonetheless, embracing bold strategies is essential for driving systemic change and improvement. Precision medicine, when properly employed, not only enhances the effectiveness of the healthcare system but also contributes to its long-term sustainability. While some may perceive it as potentially costlier, the key lies in its responsible and appropriate utilization. When leveraged correctly, precision medicine becomes invaluable in achieving a more sustainable and inclusive healthcare system. 

EF: If you were to build a sustainable healthcare system in Brazil, what three pillars would you base the system on? 

RC: A sustainable healthcare system must be inclusive, serving both the private and public sectors. Data-driven management is essential to achieve this goal but must still be widely implemented. Additionally, value-based discussions are crucial for long-term healthcare improvements. Data interoperability is necessary within healthcare institutions and sectors to ensure seamless communication. Furthermore, we need to prioritize value in healthcare, considering the long-term benefits rather than focusing solely on short-term budgets. This approach is particularly significant when innovative therapies have the potential to reduce disease burdens and bring about substantial economic impact over time. Healthcare should prioritize prevention and continuous care, emphasizing the importance of reaching as many patients as possible, ideally encompassing the entire population. It is important to remember that innovation should be centered around benefiting as many patients as possible, fostering collaboration to overcome challenges, and making a positive impact. 

EF: What are some of the main lessons you have learned in the past five years working at Novartis, and what are your aspirations for the company’s future trajectory? 

RC: One key lesson I have learned over the past decade is that healthcare operates within too many isolated divisions or silos. Transitioning from medical devices and software to the pharmaceutical sector, I observed the vast information asymmetry within healthcare. To achieve optimal results, it is crucial to position oneself as a key player within the broader ecosystem and foster collaboration and partnerships. A genuine interest in working together is the foundation for accomplishing significant advancements in healthcare. Embracing this mindset has been instrumental in my previous endeavors and remains essential in building a sustainable and equitable healthcare system. Although challenging, overcoming skepticism and labels through dedicated effort can lead to successful outcomes, such as the notable case of gene therapy. That’s why we are fostering in a culture of inspiration, curiosity, unboss (autonomy with responsibility) and integrity by upholding the highest ethical standards in everything we do, ensuring we have the courage to do what is right. 

Ten years from now, I aspire to reflect on the past and acknowledge the creation of alternative access models and partnerships with various stakeholders, ultimately benefiting a larger patient population. This vision encompasses innovative product development and transformative market approaches, enabling us to extend our reach to more patients. 

August 2023