Novartis: tackling adherence. ESPACOMP, September, 2010

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Trevor Sanders
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1 Novartis: tackling adherence ESPACOMP, September, 2010

2 Novartis is a world-leading healthcare company Leading market position One of 20 largest companies by market capitalization Among most respected companies globally Key figures Sales by region 2009 Canada and LATAM 2009 USD billion Net sales: 44.3 Net income: 8.5 R&D investment: 7.5 Asia/Africa/ Australasia US Europe 2 Global Adherence September ESPACOMP 2010

3 We have a broad healthcare portfolio 2009 net sales by division Consumer Health Pharmaceuticals Innovative patent-protected medicines Sandoz Vaccines and Diagnostics Vaccines and diagnostic tools to protect against lifethreatening diseases V&D Sandoz Affordable, high-quality generic medicines and biosimilars Pharmaceuticals Consumer Health Strong, trustworthy brands for knowledgeable consumers OTC (Over-the-Counter) Animal Health CIBA Vision 3 Global Adherence September ESPACOMP 2010

4 Our focus is on patients Our purpose is to care and cure. We provide medicines to treat and prevent diseases, ease suffering and improve quality of life. 4 Global Adherence September ESPACOMP 2010

5 Our strategy is to provide healthcare solutions that address the evolving needs of patients and societies worldwide through: Customer excellence Best portfolio Innovation Quality Products Geographical Reach Productivity Performance-Driven Culture 5 Global Adherence September ESPACOMP 2010

Decreasing physician influence Proliferation of information and increasing

6 We are all familiar with the megatrends that are reshaping the healthcare landscape Economic pressure on all stakeholders Payers Providers Patients Decreasing physician influence Proliferation of information and increasing demand for evidence Individuals assume greater ownership 6 Global Adherence September ESPACOMP 2010

7 Increasing the effectiveness of adherence interventions may have a far greater impact on the health of the population than any improvement in specific medical treatments 1 1 Haynes RB. Interventions for Helping Patients to Follow Prescriptions for Medications. Cochrane Database of Systematic review, 2001, Issue 1 7 Global Adherence September ESPACOMP 2010

Novartis has invested in a team to build adherence capabilities to deliver improved outcomes it s going to be less about risk sharing and more about a holistic approach where the pharmaceutical

8 Novartis has invested in a team to build adherence capabilities to deliver improved outcomes it s going to be less about risk sharing and more about a holistic approach where the pharmaceutical company and the payer work together to help ensure positive outcomes for a patient population, because that s really what they re after J. Jiminez, October Global Adherence September ESPACOMP 2010

9 Team tasked with providing focus around adherence, building on efforts to date Assess impact What is the programme impact? What works best? What does good like? Innovate Explore new technologies Develop new working partnerships Create Centre of Excellence Create insights base Share best tactics and design Build adherence metrics 9 Global Adherence September ESPACOMP 2010

10 Reasons for non-adherence are numerous, influenced by all aspects of the ecosystem NOT EXHAUSTIVE The patient ecosystem Health system guidelines Pharma programs Available cash Payors Physicians Varying patient and disease types Interdependent Pharmacists and other health professionals Patient mindsets Place of work Family and friends Brand taken 10 Global Adherence September ESPACOMP 2010 Where medicines are kept Media / academia

11 We are taking a holistic behaviour change approach to address the adherence challenge Understanding the individual s predisposition Their personality traits Their attitudes and beliefs Their situation Socio economics, lifestyle, physical environment Their physical health, treatment regime Their motivation Belief in the meds Their influencers 11 Global Adherence September ESPACOMP 2010

We are investing in primary research to understand the role of the individual s predisposition In Q1 2010, Novartis completed a segmentation study with Rosetta, a leading research firm, initiated

12 We are investing in primary research to understand the role of the individual s predisposition In Q1 2010, Novartis completed a segmentation study with Rosetta, a leading research firm, initiated with hypertensive patients A comprehensive segmentation provides the following: Uncovers the key discriminating criteria (behavioral and attitudinal) that drive adherence Identifies those patients who need the most support Defines how to intervene in ways that could achieve results Needs Attitudes & Behavior Research 12 Global Adherence September ESPACOMP 2010

13 We spoke over 6,000 patients, and matched half to their individual prescription data Respondents entering survey 23,657 Survey qualified and complete 6,713 (28%) Removed in Survey Data Cleaning (8%) Clean Survey Completes 6,203 Survey Data Matched to Rx Fill Data, Any Condition (High Blood Pressure, High Cholesterol, Diabetes) 3,012 (49%) Matched Rx Data 1 This cleaning rate is better than the typical Rosetta rate of 10-15% Source: Hypertension Segmentation study Global Adherence September ESPACOMP 2010

We indentified 4 clearly distinct segments in terms of their adherence attitudes and behaviours Segment 1: A-Students A-Students have the highest adherence levels

They view the doctor as a key partner, so they listen to their doctor and follow the rules.

They are more balanced and less stressed, so they don t want managing their health to be a hassle and are not looking for support.

They are overwhelmed by their poor health (more likely to have comorbidities) and because of this feel older than they are.

14 We indentified 4 clearly distinct segments in terms of their adherence attitudes and behaviours Segment 1: A-Students A-Students have the highest adherence levels because they are highly driven and organized. They are engaged in managing their health. They view the doctor as a key partner, so they listen to their doctor and follow the rules. Segment 2: Independents Independents have the second highest adherence because taking medication is something simple that they just have to do. They are more balanced and less stressed, so they don t want managing their health to be a hassle and are not looking for support. They want to take their medication and move on. Segment 3: Strugglers Strugglers have low adherence levels. They are overwhelmed by their poor health (more likely to have comorbidities) and because of this feel older than they are. They have so much to think about and do that taking managing multiple medications is paralyzing. Segment 4: Skeptics Skeptics have low adherence levels because they don t believe in quick fixes and see medication is a last resort. While they may have a relatively positive relationship with their HCP, they don t have blind faith. As a result, they seek to understand their condition and medications through their own research. 14 Global Adherence September ESPACOMP 2010

15 We are making technology investments to address situational and motivational factors 15 Global Adherence September ESPACOMP 2010

16 The Proteus Raisin TM system is the most public example of this Mobile Device Uploads data from patch and transmits to central server. Can also be used to feed information back to user Ingested Device (IEM) Sensor in pill detects ingestion and transmits signal by conduction to a wearable device Central Server Compiles data from mobile and third-party vendors and can feedback to HCPs, caregivers and patients via web or mobile device Wearable Device Patch (un-medicated) detects signal from ingested pills, temperature, physical activity, heart rate Global Adherence September ESPACOMP 2010

17 We are developing programmes to directly address motivational issues (enabled by technology) 17 Global Adherence September ESPACOMP 2010

18 The goal Benefits for all stakeholders Patients/caregivers Improved outcomes; control; peace of mind Payors reduced costs; better value for money (outcomes, efficiency) HCPs Better outcomes; improved efficiency 18 Global Adherence September ESPACOMP 2010 Pharmacists closer patient relationships ; new revenue streams

19 Number of challenges remain Internal Addressing the ecosystem in this way is a relatively new way of doing business for us Expertise to get this right is relatively scare Natural reluctance to do things radically differently Lack of consensus on how to succeed (though everyone s got an opinion) External Trust Natural reluctance to do things radically differently Genuine lack of knowledge about how this might work And certainly others 19 Global Adherence September ESPACOMP 2010

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