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Conversation highlights:
Connected Intelligence: Connecting data with stakeholders. Regarding data, we need to develop offerings that are of interest to different stakeholders, reflected in shifting portfolios from retail to complex therapies and niche disease care. Employing real-world data and evolving with the market. Stakeholders such as hospitals and payers must work together to gather insights from anonymized data sets.
Portfolio migration in companies: A general migration toward specialty care and a question of continuing to drive specialization while pharma companies are examining price vs. benefit. Market trends are currently being dictated by pipelines and acquisitions.
As technology increases, delivery becomes more complex with regard to launch access.
Generics and biosimilars as key focus areas: how to regulate effectively and make the best use of resources.
Investing in Brazil: A combination of access and scalability is ideal. Cost versus return ratio is attractive due to market size, access, and opportunities to drive new tech.
Decades at IQVIA: The role of the company has changed from a product-focused company to a connected, engaged, and critical part of the industry, following drug production during the entire life cycle.
EF: If you were to conceptualize a periodic table for Latin America (LATAM), which element would represent you, and where would Brazil be positioned on this hypothetical periodic table?
SC: Answering which element I would be is a tough question. There are numerous metals and organic elements to consider. I would prefer to be an organic element, as it would allow me to contribute to healthcare and well-being from that perspective. As for Brazil, I would probably put it in the precious metal pieces. That is where things need to work well, particularly for regional stakeholders.
There are a few regional stakeholders within the healthcare system; most of them are pharma stakeholders or med-tech stakeholders. They need Brazil to work for the region to work. When you think about the wider healthcare system, it is harder to achieve this because everything needs to function smoothly together. There are 600 million people in Latin America, and they all need to be taken care of, but we do not have anyone carrying out this role for the benefit of everyone. The Pan American Health Organization comes close to playing this role, but it does not encompass the entire healthcare system in every country. To reiterate, I would have to put Brazil into the precious metals section of the periodic table because it is the biggest country in the region, and with a lot of value from all perspectives.
Brazil is a leader in healthcare, regulatory maturity, and the better use of real-world data for improving healthcare outcomes and the efficiency of the system. We need to look at value in the entire picture and how Brazil can add value to the region. The country has a large market, and there are things that can be done in Brazil that can serve as a benchmark for the rest of Latin America. Anvisa recently approved the use of the Regulatory Reliance Program for the evaluation of new technologies within the region, and this, among other important developments, may set the stage for other countries in the region to improve the overall value that healthcare provides to the population in general.
EF: What are IQVIA's top priorities for 2024 in LATAM and Brazil? How does IQVIA tailor its services to meet the specific needs of different markets?
SC: In alignment with our corporate strategy in Latin America, we are adopting a connected intelligence approach. This involves connecting data and stakeholders. It is crucial to develop offerings that are consistent and appealing to various stakeholders, emphasizing the importance of data connectivity. For example, 10 years ago, our focus was primarily on retail within the pharmacy sector. However, with advancements in healthcare technology and a shift towards specialty care for complex diseases, our business strategy has evolved. We are now directing more resources towards providing information and services in non-retail channels across various Latin American countries, including Brazil, Mexico, Argentina, Colombia, Chile, Central America, Ecuador, and Peru. This expansion is driven by market demands and includes services catering to consumer health and the integration of real-world data into our offerings.
In the case of connecting stakeholders through real-world data, our focus is increasingly on engaging with hospitals and payers to leverage anonymized data sets for insights. This approach involves partnering with public and private payers, as well as hospitals and clinics across Latin America. By collaborating to generate anonymized data sets, we can create informative cohorts for scientific studies. These efforts aim to support technology adoption and improve efficiency in healthcare expenditure within the system. These partnerships and initiatives exemplify our current strategies in action.
We are moving more into the rare disease arena, where a lot of the global pipeline is moving and where there are a lot of unmet needs from the population. We are moving offerings to these more niche and specialty areas. Additionally, we are actively engaging with the broader healthcare ecosystem, including associations such as FIFARMA in Latin America, local pharmaceutical associations, hospital associations, and payer associations. We are also working with Anvisa and other regulators across the region to try to support them in making the whole ecosystem more connected.
EF: What emerging trends do you observe in portfolio management in Latin America? What key questions should CEOs be asking themselves in this context?
SC: This will depend on the nature of the company. We are observing that many large global multinational corporations with extensive portfolios across multiple therapy areas and a global presence have transitioned much of their portfolios to specialty care. The focus now is on driving specialization in discussions with payers. The key investment considerations revolve around the value proposition: how will your drug deliver value to the healthcare system and patients, and at what price?
This is central to the strategy for pharmaceutical companies, especially as their portfolios become more tailored to specific populations. It is no longer just about treating breast cancer; it is about addressing specific types of breast cancer with smaller patient populations. This is why continued investment in specialized therapies is important. It is as if they went through the first migration of the business or the portfolio from a retail to a non-retail portfolio, and now they are migrating again from a non-retail portfolio to a very specialized non-retail portfolio. This shift has been ongoing, and more companies are undergoing a second shift either because that's where their pipeline is leading or due to acquisitions in that area. This is an area of focus and attention.
Another key focus for many of these global companies is tied to the launch process. It is about how they launch and manage the entire launch strategy. This is not a new conversation and is now more complex because when you launch new personalized technologies, such as gene therapy, the more complex the delivery becomes. The challenge lies in the intricate delivery processes: how to integrate these technologies into the healthcare system and persuade payers of their value. Effective launch strategies remain critical, and companies must prioritize investment in this area to ensure successful adoption and market acceptance of these innovative therapies.
There is a big patent cliff coming in the next five years. This is probably the biggest one we have had in a long time and probably the biggest one we are going to have in a long time, so strategic management will be essential. On one side, for originator companies, the focus is on ensuring continued presence and success in the market. We recognize that in Latin America, originator products still hold significant potential. Therefore, planning ahead is essential to capitalize on this opportunity. On the other hand, there are companies preparing to launch biosimilars, with some also focusing on generics. Governments will need to address the impact of these launches, particularly in terms of pricing. When prices decrease due to biosimilar or generic competition, governments must decide how to allocate the resulting savings or surplus funds.
Will the savings be used on expanding access within existing molecules, or will there be a shift towards specific disease areas? This is a critical area that will be at the forefront not only for the industry but also for regulators, addressing how to regulate biosimilars while maintaining stringent quality standards. Regulating pharmacovigilance and substitution, along with optimizing resource allocation to enhance access post-loss of exclusivity, are important considerations. This dynamic will engage multiple stakeholders over the next four to five years.
EF: Why is $1 invested in Brazil worth more than anywhere else?
SC: I think there is an issue of scale in terms of the basic mathematics of any business. There is a fixed cost and a variable cost. When you have a bigger-scale business, you have a fixed cost over a wider base. When you look at access compared to other regions in Latin America, Brazil normally provides greater access to new technologies. We are currently doing some work with FIFARMA on an initiative called W.A.I.T, which measures the times to access. Brazil has pretty good access times, although there is room for improvement if we want to be the best in Latin America.
The retail out-of-pocket market is mostly the same everywhere, but when you go into the more specialty areas of healthcare, there is more opportunity for that in Brazil than in other Latin American markets. You can drive new technologies to support unmet needs within the healthcare system and have a decent market uptake.
EF: How is innovation being fostered in Brazil, and how are local capacities and preparedness in data utilization and internal innovation being leveraged to advance technology further?
SC: That is a relevant topic for many stakeholders in Brazil. There is a will to drive more local production, and in Brazil, that translates into government policy. Under the new administration, there is a resurgence of initiatives related to technology transfer and a renewed commitment to onshoring the production of essential drugs. This time around, the intent appears to prioritize quality over quantity. At one point, we had 104 different technology transfer agreements happening in Brazil. That is a high number, and I do not think many of them will go through. Most of them have not concluded.
The aim is to reduce dependency on suppliers from countries like India, China, and Korea by setting specific targets for strategic molecules. This drive in Brazil is fueled by efforts to align the will of various stakeholders toward achieving greater self-sufficiency in critical pharmaceutical production. We can look at the example of South Korea and what they did with their pharma industry over the past three to four decades. I think that would be something that would be required in Brazil if we want to change the picture. It is not something we can change overnight. We need an industrial policy. Several ministries, including the finance, health, planning, and employment ministries, must collaborate to develop a cohesive, long-term policy aimed at establishing Brazil as a leading producer of APIs domestically. There is a nascent desire to do that, and a lot of the players in the local industry are interested in it as well.
The local industry is evolving in terms of what it does from an innovation standpoint. Today, many of these local industries are quite active and already produce good results in incremental innovation. We are seeing new extended releases and new formulations. That is a reality in the local industry, and Brazil is doing a lot in this regard. Hopefully, they will continue to work with the regulators to develop a favorable environment.
Producing in Brazil is expensive. To create a favorable environment, you need to have incentives to do things and legal security to do so. Over time, improvements will also be seen from a regulatory standpoint, particularly in fostering innovation that originates in Brazil rather than relying solely on imports. The key considerations include incentivizing research and development as well as promoting local production. These are critical discussions and priorities within Brazil today. It is truly a collective effort involving all sectors working together towards innovation.
EF: What achievements will you celebrate when IQVIA reaches its 25th anniversary?
SC: When I joined what was at the time IMS, we were a two- or three-product company. We were measuring sales at pharmacies. That is pretty much what we did. There was very little in terms of providing services beyond that to the life sciences industry. We were not engaging with other stakeholders at all. Fast forward 22 years, and our life sciences portfolio has increased dramatically.
In the life science industry, we are involved in the entire drug life cycle, starting from phase one clinical studies all the way through post-launch and beyond the LOE period. This represents a huge change in what our organization does. We have increased engagement with the industry and the wider healthcare sector through the production of white papers and having a think tank. We do a lot of that within countries in Latin America, where we work independently or in partnership with industry or associations to produce this type of information. We also support linking the dots and connecting the stakeholders. Once a year, we have a conference in Brazil, where we invite people from the government, wholesalers, hospitals, and payers. IQVIA has become more interconnected as a player within healthcare, and this is what the future is about.
Many people still associate IQVIA with the commercial data we provide, but our role has expanded beyond that. We now focus on clinical data that informs health and economic decision-making, ensuring that advanced technologies reach the appropriate customers or patients. This shift reflects a broader goal of enhancing efficiency within the healthcare system overall. It is fascinating to witness this evolution of our company, and we remain committed to further evolving in this direction.
