Everybody Hates Pharma

Episode 17-Audio
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[00:00:00] ​

[00:00:05] Stefan Repin: Hello, ladies and gentlemen. This is Stefan from Platforce and we have a wonderful guest at today's pharma Sales and Tech podcast. A market access leader in Saudi Arabia in the Middle East. Very rare very, very rare. I would really like to welcome Rabab Khodary to this podcast.

[00:00:23] Stefan Repin: I think the best, I think what attracted me when inviting Rabab was her experience in market access in the pharma industry specifically. And you know, that she's a key opinion leader in the, in the, in the pharma industry. And I'm would really happy to listen to the answers to my questions. So please guys meet her, Rabab. Feel free to talk a little bit about yourself, like do an intro.

[00:00:47] Rabab Khodary: Yes. Thank you so much. First of all, Stefan to host me today in the podcast. So my name is Rabab Khodary, I'm originally from Saudi Arabia from the region of Mecca. I have 13 years of experience. It's a [00:01:00] diversified career pathway, I would say, but eight years of experience was focusing on the pharma industry in two huge operations of big companies like GlaxoSmithKline and Janssen, the pharmaceuticals companies of Johnson and Johnson.

[00:01:15] Rabab Khodary: Now the market access role and the pricing is a really dynamic I would say department of function where I had to work in evaluating and bringing the best optimized solutions for the business when it comes to access to medications for the patients and where I had to do a lot of pricing strategies and access strategies and implementing governance and framework.

[00:01:39] Rabab Khodary: Through internal to succeed and execute inpatient access externally. Now most of the therapy areas I focused on, usually in different organization you would say, or see that there is a one or two therapy area pair each part of the market access operational team. But for me, I was handling a lot of innovative products, [00:02:00] including the anti-infective established brands and including the urology and adding to the innovative, for example, HIV, specialty, rare disease and vaccines.

[00:02:09] Rabab Khodary: Adding to this I was having two years experience in the Hemato Oncology where I would say it's one of the most dynamic market.

[00:02:18] Stefan Repin: Hmm. Okay. So dear listeners, let's get back. I think they wanna understand what is market access. First of all, what is market access in pharma? Can you please like, explain what is, what is that?

[00:02:30] Rabab Khodary: So basically market access is accelerating patient access to medications, meaning that I have to bring the right treatment for the right patient at the right time with the right price. And to do this, it looks simple, or it may be, seems simple, but in reality it's a very complex process from strategic aligning with the strategic priorities of the organization to the operational processes.

[00:02:56] Stefan Repin: Mm-hmm. Okay. That's a good answer. So why is it [00:03:00] actually important for like, like patient access?

[00:03:04] Rabab Khodary: So did, I will give you one example about let's say a cancer patient. Imagine a cancer patient is highly progressing, having a severe case of a disease, and he's in need at the moment to get a chemotherapy as an example. So imagine if there is no available chemotherapy on shelf for the patient at the moment in the hospital.

[00:03:29] Rabab Khodary: What's gonna happen emotionally? He'll be devastated physically, mentally, he will be alert. His family or her family will be irritated. There will be. Negative consequences and you don't know what's gonna happen with the patient. So market access play a really important, crucial role at the level of organization and at the level of the market, and the big need for the patient to have the medication at the right moment.

[00:03:57] Stefan Repin: Okay, so what is the, [00:04:00] so I assume that would be the same core objective, like of the market access team in an organization, like get the, the right products at the, the right time, but, or can you tell me about that in, in your way? I.

[00:04:13] Rabab Khodary: So basically there are always strategic priorities for any multinational company or in the pharma industry. So one of the key role of the market access is a coordinated approach of cross-functional alignment, meaning I have to align and discuss and communicate and integrate with the approach and strategy.

[00:04:33] Rabab Khodary: The regulatory, the sales, the marketing, pricing finance supply chain, maybe medical affairs, and the government affairs and, and policy department. So we have to integrate all the stakeholders for number one. To boost up the reputation of the company, the competitive edge. Number two, to access for the patient when it comes to medication.

[00:04:55] Rabab Khodary: Now to do this, imagine the market access play, a crucial role from the early development [00:05:00] of the medication until the commercialization process, through the product life cycle, and to do this. We need to set effective market access strategy, aligning with the commercial team on their strategy to boost up the organization growth.

[00:05:16] Rabab Khodary: And number one priority is the patient access to medications.

[00:05:21] Stefan Repin: Of course. Makes sense. So what is the know-how for a market access expert like you, as an expert, and well, what's your, would say competitive edge. Why are you better than other market access leaders?

[00:05:35] Rabab Khodary: So before maybe to answer this question, I would tell you the top priority of a market access activities and market access as a function or department. And from there we can talk about the capability and the expert know-how. So number one in the market access is really important, is the evidence generation.

[00:05:52] Rabab Khodary: Real world evidence because I wanna show the value of my product or my I would say medication Number [00:06:00] two, you need to bring the right economic, clinical, humanistic value of the product to our budget holder payers I would say policymakers, providers, and even for the patient. Another thing is understanding the country dynamics and landscape and regulations and the market trend, and understand the peer or the stakeholders approach and mindset.

[00:06:27] Rabab Khodary: And from there, bringing all of this together with the suboptimal, or I would say the optimal price that would give the value for money versus, you know, the high cost that would maybe impact the health expenditure. To do all of this, you need the art of value crafting, which is the value proposition of a product.

[00:06:48] Rabab Khodary: You need to have good analytical thinking, strategic thinking, being an expert in health economics and outcomes research, and understanding how to [00:07:00] put the pricing and market access strategy. Another thing to add is business acumen. Emotional intelligence, and I'm gonna talk about it later in details.

[00:07:09] Rabab Khodary: Negotiation skills, superior communication skills with the customers, and at the end, interpersonal and communication skills or relationship building with our top customers.

[00:07:22] Stefan Repin: I like the part about emotional intelligence. I would like to discover that more. Can you talk about that one more?

[00:07:29] Rabab Khodary: So emotional intelligence for me is something that I've been practicing honestly for 10 years. Stefan I was following the books of the great author Daniel Goldman, about emotional intelligence and the power of leadership. Now, I would say that emotional intelligence is a cornerstone of a happy, personal and professional life, even to be a successful leader.

[00:07:53] Rabab Khodary: So it's basically the catalyst of the right leadership in organization. I'm gonna tell [00:08:00] you that emotional intelligence is based on, of course, five pillars, is the empathy, the self-awareness, and the social skills, self-regulation, and the motivation. Now when we talk about the self-awareness is playing a big role, especially for leadership role because you need to know and understand your emotions, your feelings, your potential, your weaknesses and strength, and you tailor your behavior and thoughts accordingly.

[00:08:26] Rabab Khodary: And being a great decision maker in any organization, Now self-regulation plays a big role when there is a chaos in specific, let's say big threat or red flag or a risk where you are very calm and you think about any risk in strategically unsolved in a very nice way and very strategic way in any organization, empathy.

[00:08:48] Rabab Khodary: Is really a big pillar because when you understand the feelings of your team as an example in an organization, you know the behavior and thoughts beha behind it. You tailor it, [00:09:00] you tweak it, you support them, you being a very diplomatic with them, and then you uplift them to work and produce double effect when it comes to the business outcome needed.

[00:09:10] Rabab Khodary: So EQ play a really big role, and it's a big pillar when it comes to even brain agility. Now this will take me to another topic where I'm gonna tell you about the brain agility model as an example where you need the secret recipe of emotions, intuition, body mind, connection and motivation and creativity and logic.

[00:09:37] Rabab Khodary: So when you have this mix, it plays a really big role even to the winning mindset of market access team.

[00:09:46] Stefan Repin: Okay, so just going back before we go back to market access, I want you mentioned Daniel, I'm a big fan of his books as well, and I think you cannot become a great leader. If you don't improve yourself, [00:10:00] meanwhile you are improving the processes and you're improving the KPIs for your team that you're leading, right?

[00:10:05] Stefan Repin: Be the enterprise or a small company. Now my question would be where does the leadership settle?

[00:10:16] Rabab Khodary: Okay, so if we say emotional intelligence, we talk about emotions and empathy. Right now, leadership. I would say it's full of schools. It's not a one school or one resource or one style. We have many styles of leadership, but the most important type that I see is important for uplifting and working not only with my team, but leadership without authority, which meaning cross-functional team is servant leadership.

[00:10:47] Rabab Khodary: Servant leadership basically is understanding the emotions and working with it and understanding the behavior. Behind a specific thought or mindset. Yes, it's important for your team, but it works well even with other teams. [00:11:00] This would really boost up transparency, trust, agility, resilience and integrity, collaboration with other cross-functional team.

[00:11:09] Rabab Khodary: And it plays a big role when it comes even to succeed as a market access, I would say lead in the organization and to execute properly. Any processes or plans externally when it comes with the other stakeholder or authorities?

[00:11:25] Stefan Repin: Okay. My follow up question would be you as a leader, like I obviously see you as a leader in the market access team. Let's talk a little bit about the value-based healthcare, right? Like how do you envision the value-based healthcare in 2030, and what's the role that it's going to play?

[00:11:42] Rabab Khodary: Yes. So to talk about this, I'm gonna give you a simple definition of the value-based healthcare. So right now there is a growing interest, especially in the emerging market, that they wanna move toward a value-based healthcare rather than the concept of high price and that's it, or volume. [00:12:00] So when we talk about the value, it means that the healthcare system is organizing activities or arranging specific initiatives for the sake of improving the patient health outcomes. Add the same thing, improving the life expectancy, the health related outcomes, and at the end, improving disease prevention or increasing disease prevention in the right forum now to do this, meaning that the funding will be based on the value of the product or value of innovation. The interesting thing, there's a huge transformation going on with the vision 2030.

[00:12:37] Rabab Khodary: And what we see right now, one of the key objective is a vibrant society. Society that looks for their health and care about their health. And when I say this, meaning that the cornerstone of this is improving the life expectancy. So in this situation, the value based healthcare will play a big role. Now the market access team is the engine.

[00:12:59] Rabab Khodary: Of [00:13:00] the value-based healthcare shaping in Saudi Arabia and any another market. And I will tell you the explanation that the market access is based on the value of products and value of innovation. Meaning that if, for example, let's give an example of the cellular and gene therapy where we, you bring adoption of a new novel therapy or technology that is really.

[00:13:25] Rabab Khodary: Highly costing in a big healthcare system, but it would give the value for money. So basically you are giving a high cost, but in relation, you are giving a patient health gains or patient health outcomes or even improvement of overall survival. So in this situation, the market access will shape the policy, will shape the environment, will understand the market dynamics, will do a socioeconomic evaluation to understand the willingness to pay from the perspective of budget holder like the payers.

[00:13:58] Rabab Khodary: And from there they will [00:14:00] manage to bring this value. Which is clinical or economic to the peers. The one challenge in here, I would say when it comes to value-based healthcare is that there is silo mentality for the peers to Im, to understand how to implement this value-based he healthcare and how to evaluate the value for the product.

[00:14:23] Rabab Khodary: Now, the market access team, They will succeed whenever they really embed the right unified value of the product among all the peers in Saudi Arabia. And why I'm saying Saudi Arabia because for example, for me, I was you know, handling total governmental sector, which meet more than 60% of the business in Saudi Arabia.

[00:14:46] Rabab Khodary: That is really looking for the national reimbursement. So we have a lot of payers. We have different mindsets. There is a different perception, and we need to deliver and communicate the right value of innovation to these [00:15:00] payers.

[00:15:00] Stefan Repin: Okay, you mentioned players. So first of all, can you name who are the external internal stakeholders for market access team and how do health authorities are obviously like stakeholders. Well, how do you, you know, how do they come into play and how do handle them correctly?

[00:15:18] Rabab Khodary: So when it comes to the internal stakeholders maybe I mentioned earlier, we have multiple OT stakeholder including from, you know regulatory perspective pricing, finance, supply chain marketing, sales, medical affairs, government affairs, and even, you know, from global to local. You know, stakeholders in the market access and imagine the beauty, I would say, of market access that you are really well recognized in organization.

[00:15:44] Rabab Khodary: And I'm saying this because you deal from the medical representative perspective until the senior leaders of the organization you need to discuss decision making. You need to go operational to shadow. For example, some of the stakeholder you need to work [00:16:00] with the team. Internally a lot from operational perspective to strategic to even decision making or, you know, giving a specific initiative at the governmental level.

[00:16:11] Rabab Khodary: For example, collaboration, strategic partnership, to understand how to put number one, the company at first, number two, to access to our innovation or medication. Now from the external part, I would call them the four Ps, the payers, the providers, the patients. And last I would say maybe the prescribers.

[00:16:32] Rabab Khodary: Now there is always a different categorization of these stakeholders, but payers are the most for us because they are budget holders. They're a big decision makers or influencers in the formulary, enlisting process in the hospitals as an example of the governmental sector.

[00:16:51] Stefan Repin: So going deeper, actually, my question would be what are, what are the key. Maybe figures, what are the key determinants for successful access to [00:17:00] medication and maybe what are the biggest challenges when you, you're facing with, the external environment?

[00:17:06] Rabab Khodary: So at say, number one market access is based on three pillars, and this will determine the success is evidence driven. Payer needs driven and last patient-centric. If you have these three key players, I would say they will determine the success and under each pillar there are multiple activities that play a big role.

[00:17:28] Rabab Khodary: And I would say. The value crafting or value proposition crafting for the payers is important because it will deliver the right needs and it'll tackle unmet medical needs in the population. Now, if we come to the challenges, challenges always are diversified. But in an environment like the Saudi market as an example, Stefan, and you can see maybe the big huge jump in transformation from different perspectives and sectors.

[00:17:56] Rabab Khodary: There is a lot of changes. It's complex, unpredictable. There are many [00:18:00] dynamics that's going on. So we need number one, two, landscape the country, understand the market trends, the regulations, the policies, how to shape the market and how exactly the macro environment is coming to play in a way or other.

[00:18:15] Rabab Khodary: So once you know this, you will tackle any challenge now from perspective of, I would say regional, which is hospital based. The formulary or the pharmacy therapeutic committees play a big role in technical evaluation, so we really need to understand the needs of the payer, and we really need to understand how to optimize the resources and allocate the budget in a way other to support them when it comes to bringing the value of innovation.

[00:18:42] Rabab Khodary: And from there, you know, we can surpass or overcome this challenge.

[00:18:45] Stefan Repin: Okay. So there is one important point. The unique value proposition or the UVP is very important for me as a marketer because we have like Platforce where like I'm seeing not many companies have a unique value [00:19:00] proposition. They're all like sort of generic. I wanted to ask you like what are the key drivers and why are they important when you are crafting a value proposition for products?

[00:19:09] Rabab Khodary: So one thing we have the global value this year, right? So basically it's a huge document where it shows in details the economic, I would say, and the humanistic and the clinical differentiator of our medication versus the competition or the, let's say, the available standard of care now. Crafting the value proposition is important because when I'm gonna go with to the payer, I'm not gonna go with a 100 pages of value, global value, right?

[00:19:37] Rabab Khodary: I'm gonna customize it based on the market needs, based on whatever the regulations available when it comes to value based healthcare, as an example, based on the direction of the payer and the mindset of the payer. Now, the value proposition play, I would say a crucial role because. We want to bring the value of the product versus let's say [00:20:00] the high cost of the product.

[00:20:02] Rabab Khodary: We want to make sure that the impact on the healthcare spending will not be high. If there is a value for money, which is the value of innovation, and that's why very important to keep engaging externally face-to-face with the customer, understand the market need and the drivers and the decision-making processes that comes from these payers.

[00:20:27] Stefan Repin: That makes a lot of sense. So how do you like regulators? Obviously regulators, like, you know the government obviously they put a lot of pressure right on you. How do you solve the innovation problem? Like how do you innovate?

[00:20:39] Rabab Khodary: Yeah, there are many factors regarding this, but I would say number one if you bring a task force, for example, where you have the company introducing themself through memorandum of understanding or strategic partnership with, for example, the Ministry of Investment, the Ministry of Health, or other authorities that comes into play [00:21:00] that play a big role now to bring innovation.

[00:21:03] Rabab Khodary: I think top number one is awareness. So we need to really increase awareness about the importance of innovation, the importance when it comes to health gains for the patients, and the importance when it come to the area, why our product and in which disease area and why to this patient population X, for example.

[00:21:25] Rabab Khodary: So the awareness plays a role, playing another role is the advocacy. And, you know, being a key participant in different forums and conferences, that really brings innovation as a key concept and plus that we want to show how important is. Patient access to medication with sustainability and consistency.

[00:21:48] Rabab Khodary: So market access doesn't only bring innovation patient access or patient access to innovation. It brings or secure the current medications to be on shelf with the support of, [00:22:00] for example, the key account managers and, you know, the tender managers or the tender function.

[00:22:05] Stefan Repin: Okay. I have maybe two, three more questions for you and one of them. We mentioned Saudi Arabia so much, right? Hmm. Maybe you already spoke about it, but just to emphasize, so what's the one in the market such as like Saudi Arabia and nearby markets, right? How market access comes into play when we talk about value-based healthcare.

[00:22:27] Rabab Khodary: Yes. So maybe we talked about this earlier, but I, I'm gonna tell you a very nice example

[00:22:34] Stefan Repin: Awesome. .

[00:22:34] Rabab Khodary: So now, if we are having a growing interest in the value-based healthcare in Saudi, and we talked about the, maybe the vision 2030 and the vibrant society and the idea of the health outcomes and focusing on the patient at first. Now for example, if there is a specific let's say novel therapy to be adopted as a new technology in Saudi Arabia, but the concern is the high cost.[00:23:00]

[00:23:00] Rabab Khodary: The good thing about market access that we always come with innovative solution, meaning that we can come with special access schemes, I would say, or a specific agreement that, for example, this is between the company or the manufacturer and the payer in which shows that there's hit battles win-win situation where we're gonna bring this technology to Saudi Arabia to deliver it to the patient.

[00:23:25] Rabab Khodary: However, There is a management to the coast and this happening through economic modeling or let's say health economic evaluation, like for example, cost effectiveness or budget impact models. So here, there a big focus on the value-based schemes. Now there is another field or another I would say definition.

[00:23:46] Rabab Khodary: An interesting topic that will come when it comes to market access is managed entry agreements. If you heard about it Stefan. So managed entry agreement. Have a different definition in different literature or resources. [00:24:00] However, the idea that it's very specialized schemes where it's giving innovative solution to the you know, to the peers.

[00:24:07] Rabab Khodary: But at the same thing, it tackles clinical uncertainty about innovation or new novel therapy and in which. At the end, it'll bring the novel therapy, but at the same thing, it will tackle the concern about the healthcare impact that's gonna come with this delivery of this, you know, medication.

[00:24:30] Rabab Khodary: And under this managed inter agreement, we have a different categorization.

[00:24:34] Rabab Khodary: Example is paid for performance or you outcome based models.

[00:24:39] Stefan Repin: Interesting. Okay, so basically you have, you have market access is quite complex, and I'm wondering like, what, how do you like keep yourself motivated and how do you keep, you have like regulators, you have internal, external stakeholders. All of them have their own agendas. So, how do you serve foster? A culture of [00:25:00] innovation within your own team and you know, the teams you work with.

[00:25:05] Rabab Khodary: So I think number one, and this is always my priority, is mental and physical wellbeing. If you have a very good mind and body connection, Stefan, you will have a triple effect in your productivity when you work in any business in an environment, like a very dynamic or complex like market access, where you have to deal with a lot of challenges internally and externally.

[00:25:30] Rabab Khodary: Number one, I would say you have to be very calm, to clear your mind, to have a growth mindset, to think positively and to have the right solution at the right moment. So you have to really focus on your physical, mental wellbeing, and I would say stay, you know, stay hydrated, oxygenated sleep well eat well, exercise, and at the end, simplify any process in your mind.

[00:25:56] Rabab Khodary: It'll keep everything very simple and you'll be always [00:26:00] creative and motivated.

[00:26:01] Stefan Repin: Awesome. I have my last question. So what would you suggest. Let's say up and coming market access leader, someone who wants to learn more about market access, what would you suggest to that person?

[00:26:13] Rabab Khodary: I would say there are two key pillars to do is the tools of market access. And face-to-face in the field. So to do this you need to read a lot about market access, pricing, health, economics. You need to use tools that, in a way or other, would support you from technical perspective to even operational perspective.

[00:26:37] Rabab Khodary: And going to the field is number one, because the more you go, the more you observe. The more you evaluate, the more it would support you to shape the environment of market access.

[00:26:49] Stefan Repin: That, that's the, that's the best answer I've heard so far about market access. And I wanna add this we had a, a personal chat with while before this. So if you guys wanna learn about market [00:27:00] access, join her in Budapest. That's a place where I am right now. Join her for the market access summit / conference in October.

[00:27:07] Stefan Repin: Am I correct, Rabab?

[00:27:10] Rabab Khodary: Yes. Hopefully if I'm getting the visa on time. Yes.

[00:27:12] Stefan Repin: Yeah. So meet her, you know, you'll be able guys to ladies and gentlemen, you'll be able to, to meet their other leaders like such Rabab and you know the best knowledge you get is when you learn from each other. So you're welcome for the consideration. Thank you for the wonderful podcast.

[00:27:29] Stefan Repin: I'm looking forward to see you in another podcast episode maybe in year and a year from now. Thank you for the insight. It was very valuable.

[00:27:38] Rabab Khodary: Thank you so much Stefan. It's a pleasure and looking forward to meet you face to face soon.

[00:27:43] Stefan Repin: Thank you so much. Have a good one.