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Features
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11/1/2011
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The Big Interview: Michael Cann
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Michael Cann, director of generics at Actavis and chairman of the BGMA, has not changed all that much since his halcyon days as a cricketer at Glamorgan during the 1980s, discovers Neil Trainis...
You're not going to put that in the paper,” Michael Cann snaps jovially when asked if he really is a Cardiff-born Reading season ticket holder as we settle down to talk about pharmacy reform, generic medicines and his deep connection to sport in a tidy room at the College Hill Life Sciences campus. “I was born in Cardiff and I am a Cardiff fan but I live in Reading. I do get to Cardiff games. I went to the (Championship) play-off final when Cardiff lost to Blackpool (at Wembley in 2010). I've got my home town and I've got my old home town, so I do follow them both. There's an admission of guilt between the Wales and England border. So I'm suitably embarrassed.” Conundrums about where his allegiances will lie when the two clubs clash in this season's Championship seem insanely superficial next to the kind of decisions he undertakes as director of generics at Actavis and chairman of the British Generic Manufacturers Association. The kind of decision-making that saves lives.
In March this year he claimed, as BGMA chairman, that there was “a moral imperative on all of us in the industry, in the supply chain and the government to ensure that generics are used to the maximum extent.” The notion that generics, a roaring billion pound industry, is underpinned by a business-driven imperative as much as a morally-driven one almost jolts him into jumping from his seat. He leans forward and retorts sharply yet placidly: “No, not at all and I'll explain why. If you take the usage of simvastatin since it came off patent, it has grown exponentially and the reason it has grown considerably is, when you compare its cost with the price of the originator medicine at the off-patent price you, for the same amount of money, can treat millions more patients pro-actively.” For a man whose professional life within two large bodies is consumed by generic medicines, he is unsurprisingly robust in his defence of an industry which, at the last estimate, was said to save the National Health Service, desperate to preserve £20 billion over the next three years, £9.5 billion a year. As Michael talks about generics he tantalises the mind, cranking up the listener's desire to know more. And his argument is very persuasive. “So actually, we've moved healthcare improvement forward considerably by enabling the product to become more accessible for more patients at the highest quality for the lowest possible cost,” he says.
“That's where I come from a moral perspective. When it becomes readily affordable, prescribing practice changes considerably. That enables access to a much wider range of patients and that's the real benefit the system is supplying to the UK.
“Why do I think it's a moral obligation? I believe there are certain aspects of branded competitors that prevent the uptake of generic medicines. That can be in off-patent launches or some of the tactics they employ with PCTs, given the marketing power that they have versus the generics manufacturer. So, in the absence of our members having the marketing power that the branded manufacturer has, we have to call upon people to do the right thing, not because it drives up the volume of sales for generic manufacturers but because it gives patients a much wider access to medicines.
“I could give you five or 10 examples of molecules, post-patent, that have had a significant uptake in prescribing. That, in turn, frees up expenditure on real products which have clinical need, be it oncology products or more sophisticated medicines out there. So you've got a double effect in the moral obligation.”
There is no doubting his passion for generics but there is no self-fulfilling, misty-eyed wonderment. There is a genuine concern for the well-being of people. “I think your readership will find it really interesting to understand the positive benefits they bring through their dispensing of generics. I've got a little list here,” he says, fixing his eyes on a sheet of paper in front of him. He describes the generics industry as “maturing” before revealing that “taxpayers have saved £9 billion a year by our last calculation, 927 million items were prescribed, a 4.6% rise from 2009. Your readers are dispensing these, we're manufacturing these and they need to know that impact of what they're doing. I think that'll add a bit of oomph to the article.”
Passion
That passion seeps into the future of community pharmacy under the Government's reformation of the NHS. “I think this is an exciting time for pharmacy,” he asserts. “There's a significant amount of change going on. The agenda is changing. It is looking for alternative solutions to provide services traditionally supplied by other providers and pharmacy is pretty well galvanised around the New Medicine Service. That's something we at the BGMA recognise as a real positive, anything that helps improve dispensing of product and patient-pharmacy interaction and the ongoing agenda around the NHS reforms, I think pharmacy is fantastically placed to galvanise itself and take advantage of the opportunities and show it can do a great job.”
The original blueprint for the health and social care bill, as proposed by a besieged Health Secretary Andrew Lansley, has been revised and there remains uncertainty about how the watered-down proposals will benefit pharmacists. “I think ultimately it will (have benefits) but its one thing to pass legislation and another thing to actually enact and put things into place,” he says. “There are different structures which you would carry down to local level, which is where it really matters. Whether we say it's watered down or not, the reform bill is going to make big change and opportunity for pharmacy.”
The biggest contention for the Future Forum, its chairman, professor Steve Field, recently conceded, was idea of competition in health service provisioning and the role of Monitor. “I can fully understand any worry about any role of some central organisation such as Monitor changing the framework but we need to see the detail that comes out in the bill,” Michael says. Typically, he finds it hard to maintain the conversation without mention of generics. “What I can say from a generics perspective is competition has driven enormous societal and patient benefits and enormous benefits for pharmacy and for medicine. Within the generics industry we've got one of the most competitive markets in the world, if not the most competitive market in the world, and that's driven service standards, product development, innovation, low costs, improved supply chain, increased service levels.
“What I am qualified to talk about is what competition has done for the NHS in terms of the generics industry, which has been substantial.” An attempt to direct the talk towards community pharmacy, and the question of whether pharmacists are ready and willing to embrace change, is taken however. “I think they are up for it,” he suggests without any hint of a flinch. “I get the feeling it's a spectrum of preparedness but I also get the feeling from speaking to individuals that some people will be better at some things than others, whether it's chronic disease management, whether it's other services they supply. They won't all be best in class at all of them.
“People will show relative improvement in their chosen area, whatever that may be, whether it'll be a large chain or a multiple or independent. The other thing I'd say is that sometimes people don't quite understand the level of interaction that is happening currently and a lot of the good work is not currently not being recognised in terms of the work that pharmacy does with patients already.” Where has that lack of recognition arisen from? “Traditionally, pharmacy possibly hasn't shouted about it and they're raising it now, or traditionally they have not been remunerated or recognised for it,” he replies. “But MURs and the New Medicine Service are the right and proper way forward to recognise and incentivise those type of behaviours. Actually, there's a lot of stuff pharmacy does, particularly with prescription medicines, which fall into the chain of services directed at the public. There are some interesting challenges ahead in terms of their interaction with the public health boards and these sort of things but this is something that will play out.”
Pharmacy funding for 2011-12 has caused outrage amongst many pharmacists adamant that they have been left high and dry by PSNC and the Government. There is also the New Medicine Service under the Pharmacy Contract to consider but Michael cannot suppress a smile at the mention of the name of Hemant Patel, the four-time former president of the now defunct RPSGB and secretary of North East London LPC. Patel told Pharmacy Business that he believes some pharmacists are interested only in making a profit and not too interested in immersing themselves in the new advanced services. “I'm not going to call any pharmacist lazy am I,” Michael says “From what I've heard anecdotally, yes, there will be some who are slow to adopt it like always but I would hope that most pharmacists will embrace it.”
The multiples have slammed the latest funding package and warned that pharmacies will either reduce their services or go out of business as a result of severe cuts. Michael maintains his poise. “Listen, there's a lot of cost pressures in all businesses at the moment and that falls into the cost pressures that we're all having to bear at this moment in time,” he says. “The NHS is looking to save its £20 billion under the QIPP (Quality, Innovation, Productivity and Prevention) agenda, so we're all having to control our costs very closely, be it a generics manufacturer, a wholesaler or a pharmacist or anybody else in the supply chain for that matter. We're all under the same set of cost pressures and economy drivers.” Inevitably, the subject of generics proves inescapable once more. “What I would say is, as part of the funding agreement, the balance between purchase profit and service provision is changing and that can only be a good thing in the long run as long as the incentives remain for effective and economic dispensing of generic medicines, because that's still a large part of the funding model and an important part of where the BGMA comes from.
“The purchase profit is agreed between PSNC and the Department of Health and our role is to ensure medicines can be supplied within that framework very cost-effectively. NHS expenditure would be £9 billion higher without effective dispensing and supply of generic medicines in the UK. So there wouldn't be a discussion without the effective supply of generic medicines and without the pharmacy funding contract because it is that system that provides the benefits to the NHS.”
In our industry, in generics, it often feels like an uncomfortable place to be. There's a lot of change, a lot of adaptation you have to go through.
Excitement tinges his voice as he speaks of the looming 'patent cliff', a period that will see some of the biggest drugs lose their patency. “Teetering on the edge,” Michael says smiling once again. It is a phase that could trigger public disputes between drug heavyweights of the kind that erupted this year when Teva launched generic atorvastatin in the UK and were vigorously pursued by Pfizer, the makers of the world's best-selling drug Lipitor, for a “flagrant breach of Pfizer's patent rights.” Michael is not interested in talking about looming court battles or mud-slinging, only the benefits such a period will bring for patients and pharmacy. “If you roll that forward into coming years, you have a range of products coming of patent, a significant value of products, that I'm sure will benefit pharmacy profit moving forward, particularly in 2012, with some large molecules coming off patent,” he says. “Everybody should benefit from that as the branded originator companies have already benefited from the patent grants they've been awarded. It is then time for the generics to move in, supply the products for pharmacy to generate its profit, drive down the overall cost of the drugs bill, make medicine more accessible for the patient and that is a fantastic system where everybody wins.”
He holds the firm belief that patients with long-term conditions in a new-look patient-led NHS will see and actually feel the improvements to services under the NMS. “A lot of this happens quite informally any way. This formalises the process and the follow-up mechanisms are very sensible,” he says. “Anything that enhances the patient experience when they are first prescribed a medicine has to be a good thing and I think you'll find a lot of pharmacies already do this, particularly those in close communities. For those pharmacies who don't, this will be a good opportunity to get closer to their patients and that can only be a good thing. It can only help to reduce dispensing errors, it can reduce mistakes whether a prescriber or a dispenser, it can only help and enhance the patient compliance and patient understanding, particularly on polypharmacy. It has to be a huge benefit to the patient, in terms of the system and the service delivery, hopefully will have a better healthcare experience.”
Generic medicines, pharmacy dispensing and clinical services all seem a long way from hitting boundaries and taking wickets as a first-class cricketer with Glamorgan. His County Championship debut in 1986 and maiden first-class hundred against Somerset at Sophia Gardens in 1989 feels like a bygone era. It is almost surreal to think that the arrival of Alan Butcher, currently the coach of Zimbabwe, precipitated his release at the end of the 1991 season. Michael finds humour through the memory of that disappointment. “Gosh, this is going back 20 years. I did everything, bat and bowl. No-one else agreed,” he says laughing. “I had a great career, it was a lot of fun, there were a lot of very good players around and you had to fight for your place. The reality is you take it as far as you can go. There comes an end to everything.” He stills plays the odd game for his local village, Sonning Common in Oxfordshire, but the Glamorgan experience shaped him. “I played for 10 years, from 18 to 28. There were great experiences and I made great friends all over the world. It does help shape your future personality around the challenges we take on now. There's something from back then that still plays out in my day-to-day world.”
How did his cricket career mould the Michael Cann of 2011? “It's about dealing with people, working in teams but also taking personal responsibility on board,” he says. “It's about interacting with people but at the same time compete. You're trying to make stuff happen in a team environment but ultimately you're accountable to yourself. And continuously finding yourself in uncomfortable situations.
“That can play out, quite interestingly, into the business world. In our industry, in generics, it often feels like an uncomfortable place to be. There's a lot of change, a lot of adaptation you have to go through and they're things that have served me well. You have to continually think around all the members' needs not just your own and there's a sense of personal accountability. They were great experiences that shaped the things I do on a daily basis.” He gets up, shakes my hand and, smiling again, says 'howz that!'
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