Note: 2023 data not yet available; ranking is relative, not absolute
Source: Annual reports, companiesmarketcap

However, with the advent of new medications for diabetes, obesity, and Alzheimer's disease, we may be standing on the precipice of a new era of expansion in primary care.

Increased accessibility to healthcare information and patient engagement have made healthcare monitoring and management more straightforward than ever before. However, the strain on healthcare systems is a mounting issue, necessitating pharmaceutical companies to assist in enhancing capacity.

While primary care has always been a cornerstone of healthcare, awareness of its ability to generate innovation is being recognised despite important developments in this area over the past decade (Figure 2). Yet, the affordability of drugs for a larger population is a contentious issue and this is similar to the challenges faced in demonstrating value by specialty medicines, which cater to smaller patient populations but have much higher price tags. However, they differ vastly on the challenge of payers accommodating the budget impact.

Figure 2. Development of novel assets for large population disease states has not been silent despite the focus on oncology and specialty

Source: IQVIA Consulting Services Analysis

It is imperative for the pharmaceutical industry to become well-versed in the supply and demand dynamics of medicines as well as understand (phenotype) the underlying multifactorial causes of obesity to ensure that HCPs are adequately equipped to manage the complexities of the disease and provide an optimal patient experience. Moreover, the evidence surrounding GLP-1s indicates that their benefits extend beyond weight loss and a more granular understanding of these indications, and their underlying populations can help prioritise patients that need treatment the most while supply is low.

This potential for segmentation of the market based on phenotype or comorbidities will allow for smarter prioritisation for reimbursement of particular segments to maximise budget impact.

However, the industry’s grasp of primary care market dynamics is limited and dated, hampering our ability to address challenges effectively. For instance, in Europe the imminent retirement of a significant number of HCPs could potentially alter the landscape of main prescribers and their prescribing habits.

GLP-1s appear to be a long-term treatment strategy for maintaining weight-loss benefits. However, this necessitates consistent tracking and data generation over time. Furthermore, reimbursement models for large markets like obesity may need to be restructured, e.g. they could mirror models observed for vaccines where countries pool resources to purchase the drug on a large scale, thus reducing cost and ensuring supply.

Secondary effects also warrant consideration. For example, treated patients will impact downstream healthcare like pain management. These are the questions that the pharmaceutical industry must grapple with as we move forward into a new era of growth in primary care.

Q&A

What are the challenges on commercialising drugs for obesity?
Commercialising drugs for obesity present unique challenges around the recognition of obesity as a disease. This involves shifting societal and medical perceptions, establishing appropriate reimbursement frameworks, and supply channels. These challenges necessitate significant efforts in education and infrastructure development.

Are there partners available to help build the capabilities to treat obesity?
Yes, disease associations, such as the European Association for the Study of Obesity (EASO), are driving a better understanding of obesity. These partnerships, however, require time to align multiple stakeholders and identify opportunities where funding can be utilised effectively.

Is there more that companies should be doing to collaborate with health systems in order to accelerate stratification of patients?
The introduction of GLP-1 medications will drive the need for improved diagnostics and phenotyping for obesity and follow-on indications, which is pushing science to new frontiers. Companies and health systems should work together to collect data on a large scale which would not only enhance our understanding of the disease and allow us to stratify patients to a greater extent, but would also benefit science as a whole.

Who should lead science progression, pharma or academia?
It should be a collaborative effort between the pharmaceutical industry and academia. This partnering approach ensures alignment in objectives, fostering transparency and open access to data. Partnerships offer a viable solution for data gathering, ensuring that all involved parties can access and utilise the information necessary for their research.

NOTES

This article has been adapted from a panel discussion given by:

• Oliver Staples (Moderator), Managing Principal, IQVIA Consulting Services
• Chris Isler (Moderator), Managing Principal, IQVIA Consulting Services
• Nuno Couto, VP Obesity TA International Ops., Novo Nordisk
• Anna Cerdeira, VP Global Head Commercial, Development Assets, Innovative Medicines Group, Grünenthal
• Prof. Ralph Schimmer, University of Zurich, Medicine Dept.
• Orlando Oliveira, SVP International, Mirati Therapeutics (now BMS)

at the Switzerland Strategy Conference held in Basel on 7 February 2024