Precision medicines – delivering to patients
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The document discusses the challenges and opportunities for precision medicines and new distribution models. Precision medicines are often high cost with low volumes, requiring new infrastructure, equipment, and handling procedures to maintain cold chains, sterile environments, and track batch recalls. This is driving non-traditional models involving increased homecare delivery, patient support programs, pharmacist education and roles, and outcomes monitoring. It also creates opportunities for new big data through improved adherence tracking, which can provide insights for manufacturers, pharmacies, and consumers if shared through data and service-oriented platforms extending from pallet to patient. Overcoming these challenges requires trust, care, partnership, dedication and innovation across the healthcare system.
Precision medicines – delivering to patients
- 4. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. About Us 4 Presence in more than 25* countries A global leader in pharmacy‐led, health and wellbeing retail with over 13,200* stores in 11* countries One of the largest global pharmaceutical wholesale and distribution networks with over 390* distribution centers in 20* countries The largest retail pharmacy, health and daily living destination in the USA and Europe One of the world’s largest purchasers of prescription drugs and many other health and wellbeing products Over 400,000* people employed * Figures as of 31st August 2016, including equity method investments, using publicly available information for AmerisourceBergen.
- 5. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. We’ve always been at the forefront of new distribution models 5 Channel or product specific RWM Traditional Patient at Home Homecare Homecare / Home Delivery Hospitals Pharmacies Specialities Primary care medicines FR, DE UK, IT, ES, NL Ambulatory Patient All FR, IT, NL, ES, UK All :fee per service :Margin on product All Pre-wholesaler Wholesale Agency / DTP Commercial relationship All All UK, NL DTP: Direct To Pharmacy; RWM: Reduce Wholesale Model Manufacturer
- 6. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. Precision medicines are expensive compared to conventional medicines • Increased working‐capital needed? • Stock holding ability • New equipment/facilities to be funded • Loss/damage of product 6 € Volume Conventional manufacturing – low cost, high volume Precision medicines – high cost, low volume? The genome specific treating Hep C drug Sovaldi costs c€14k per pack Glybera – a gene therapy – costs $1m per treatment European Distribution Centre High cost medicine orders from the local market are distributed from the Alloga European Distribution Centre directly to hospitals or specialist clinics in 24 hours (hub and spoke model)
- 7. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. Medicines innovation is driving non‐traditional models • Patient Access Schemes • Unlicensed drugs • Unforeseen future requirements • Clinical • Regulatory 7 Companies that source and supply unlicensed medicines
- 8. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. Handling requirements differ • Specific temperatures • Packaging • Fragile products • Outer packaging/dose‐relationship • Handling, e.g. sterile environments • New facilities, equipment, training, SOPs 8 Xeljanz (drug for rheumatoid arthritis) require storage at 20– 25oC Alcura cold chain validation • Medicines packed in insulated boxes with cold/frozen packs • Packed in validated way controlled by SOPs to maintain cold chain conditions for at least 48 hours (summer and winter) • Medicines can be removed from vehicle, kept at place of work and stored without using ‘staff fridge’, or be returned – all within controlled supply chain so can be reused
- 9. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. Increasing number and type of manufacturing facilities • Efficient and responsive distribution of biomarker and their drug treatments • Shelf‐life of medicines • Specialist manufacturing, e.g. lab vs hospital 9 3D printing could allow for near‐ patient printing of a ‘personalized pill’
- 10. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. Need for patient support increases • Pharmacy vs homecare delivery • Patient support programmes • Adverse events profiles • New training • Funding • Batch recall • Testing prior to treatment 10 Pharmacists able to vaccinate Pharmacist‐led vaccination piloted (not yet nationwide)
- 11. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. More outcome measurement and feedback loops to clinicians • Pharmacist education changing • Reimbursement reliant on outcomes • Monitoring / testing • Use of technology • HCP (e.g. homecare) collect data, or bypass HCP? • Patient / automatic • Adverse event reporting • Labelling / tagging and tracking 11
- 12. © 2017 Walgreens Boots Alliance, Inc. All rights reserved. Creating an entirely new big data set 12 Consumers • Convenience • Fast, efficient prescription fulfilment • Speed of collection • Stock availability • ‘Online banking Pharmacies • Control over workload • Workflow management Manufacturers • Improved Adherence • Access to consumer • Information and insight Data / CRM / Service Orientated (API) Extending the supply chain – true pallet to patient