Breadth of vision
Viatris’ broad product remit gives it a unique perspective – and an imperative to collaborate widely across the health sector, UK country manager Matthew Salzmann tells Arthur Walsh
‘Breaking down barriers’ is a common refrain in healthcare discourse in 2023; it even made the strapline for our June cover interview with ICB chief pharmacist Shabina Azmi. Stakeholders from across the health sector are increasingly aware of the need to work more closely together and pool knowledge to improve health outcomes.
While this call for collaboration seems intuitive enough when coming from publicly funded healthcare providers, it can be as more of a surprise when it comes from large corporations, which stake the success of their business on their market share.
But it’s an ethos that is evidently dear to Matthew Salzmann, UK company manager at Viatris, a global company formed in November 2020 through the merger of Mylan and Upjohn, a legacy division of Pfizer. A native of Australia, Salzmann held a number of roles at Pfizer before the merger – and describes healthcare silos as one of the “wicked problems” he is determined to solve.
“There has to be a more collaborative way of working,” he says. “I know from our side that in the past there’s been a very competitive mindset. We want to break down silos; I really do want to be seen as a facilitator.”
Viatris has a broad product portfolio. As well as producing active ingredients (the company is the largest producer of generic HIV antiretrovirals), it owns a wide range of branded and generic Rx medicines, as well as some well-known OTC lines. “Because of our portfolio, because of our size and scale, we have relationships with everyone across the value chain,” Salzmann says. “We want different people coming around the table and having a conversation around building on Covid and addressing some of these wicked problems.
“We have round tables where we have key knowledge from industry people – the recent one was the flu. We have key members from pharmacy, politicians and patient associations.
“How we’re perceived by industry stakeholders is that we’re different – we’re not an originator, we’re not a generic company, but we’ve got both of those things in our portfolio; we’ve got OTC. We’re not in a box, we straddle a lot of different camps and so we try to come across as more rounded.”
This has implications for the way the company engages externally. Salzmann says Viatris is perhaps “more pragmatic, because we need a solution that works across a very broad portfolio, whereas some other suppliers and manufacturers have a very niche portfolio – they are very strongly advocating, rightly, for their business. The breadth of our business requires us to take a more whole system view”.
He adds: “We have a foot in all camps, and because of that, we have a vested interest in making sure all of those camps are sustainable.”
‘Access’ is another big word for Salzmann, by which he means ensuring people can get the medicines they need. He sums up Viatris’ raison d’etre: “Our mission as a company is to empower patients to live healthier at every stage of life, and we do this through trying to build value-based partnerships.” He sees community pharmacy as a key player in this effort.
Salzmann points to the company’s pedigree: Viatris as an entity may be barely three years old, but the legacy parts of its business have been in the UK for over 60 years. “We have a very broad portfolio from early in life to end of life care, across 10 therapeutic areas. We supply over five million UK patients annually with our medicines,” he explains. Salzmann spent 11 years at Pfizer before taking the top role at Viatris when it formed. “I’ve had a very broad career, working in consumer healthcare, manufacturing and commercial, on portfolios and products ranging from OTC to prescription specialist products,” he says.
Working with pharmacy
Salzmann describes Viatris as a friend to the UK’s pharmacies, saying that “when pharmacy does well, we do well”.
He elaborates: “We are a very strong advocate of the role that community pharmacy can play. One message that we advocate strongly is that healthcare should be seen as an investment, not a cost. That mindset change needs to happen at all levels, particularly within government attitudes to community pharmacy.”
Funding is a perennial concern for pharmacy contractors, particularly in England. Does the Treasury’s pounds-and-pence approach miss out on wider potential? “Absolutely. It can’t be disputed – pharmacies are the front door to the NHS; there is no other place where you have that level of access. In every other part of the NHS, you have to go through somebody to make a booking.”
He speaks of the “unlocked potential” to reach those living in areas of higher deprivation and inequality: “That potential to relieve pressure and bring about a shift in population health is incredible, that’s why we want to have really strong partnerships with the sector.”
Of course, there are challenges. “Pharmacies have an incredible amount of change to deliver, but that change delivery is being made difficult by a number of things.” He cites the contractual framework in England not being linked to inflation, “so with all the services and commitments they’re signed up to, they feel at a slight disadvantage; if you add up all the inflationary increases of the five-year period, it’s quite a loss”.
How does Viatris engage with the sector? “We have a dedicated business unit; we have relationships with all the big chains as well as the NPA. We also connect with the BGMA and government stakeholders – we really do push for constant engagement and spend time trying to bridge the divide in terms of pharmacy, general practice and hospitals.”
This ties neatly into the company’s overarching goals. “We want to reduce healthcare inequalities,” Salzmann says, citing as an example the different outcomes in women’s health and other condition areas between the northern and southern parts of England.
Pharmacies stand to benefit from the current ethos of devolving commissioning powers to local bodies, he says: “For most of the integrated care systems (ICSs) that are forming, there’s going to be a pharmacist as part of those systems and governance structures.
“And we are really excited about independent prescribing and some of the service delivery opportunities. Pharmacy has never been in a position where it had more proof points – Covid was the best thing for pharmacy to demonstrate its ability. That can’t not be recognised.
“The success of pharmacy in Covid was a different mindset and way of working. But at the back of that was investment for things like vaccine delivery. My key takeaway – and this is what we advocate for all the time – is that the sector needs to be nurtured, it needs to be seen as an investment and not a cost.”
Harnessing data is going to be key to improving health outcomes, says Salzmann: “I think data is the next big health intervention.” This is a key focus for Viatris. “We are striving to use some of those data sources that are freely available to inform some of our decisions.
“We all work under constraints, whether it’s resources or time. Using data to pinpoint the areas with the most potential to create the greatest impact can be powerful. Within the NHS, they generate vast amounts of data that I think is not fully tapped in terms of its potential.”
Salzmann cites diagnostics as one lever to improve access to medicines: “Our portfolio is broadly quite cost effective, so I don’t feel it’s the cost of these medicines limiting access – it’s the diagnostics. A lot of these conditions are silent, like elevated blood pressure or cholesterol, where there are no obvious symptoms.
“This is probably another area where pharmacy can support – if we want pharmacy to take a broader role in care delivery, we need to help them diagnose patients quickly.” He describes current pathways involving repeated GP appointments as “quite clunky”.
Of course a lot of this rests on pharmacies being able to get read/write access to patient records, and progress there has been sluggish, hasn’t it? “I think there is a plan, we work very closely with NHS Digital,” Salzmann says. “My warning there is that there are significant cost saving initiatives being put across the NHS. I just hope these savings don’t slow down progress on some of these key barriers – it really does impact the level of care.”
What conditions is Viatris focusing on in terms of product acquisitions? “Our strength is in our broad portfolio,” says Salzmann. “The company has declared focus areas in terms of new pipeline acquisitions. Gastro would be one, and ophthalmology. We have a very strong presence in allergy as we supply auto-injectors. Men’s and women’s health are two other areas where we put energy into improving patient outcomes as well.“
The company’s product portfolio is aligned with government health targets in areas like weight management, sexual health, smoking cessation and CVD, he says: “We talk about innovation a lot in pharma, and for me innovation needs to happen in those areas. It’s not always about having a new kind of medicine; innovation needs to be in the delivery of population health goals.”
Salzmann stresses the importance of tackling non-communicable diseases. “If you take a global look at it, 40-41 million people die annually from some of these diseases. The impact on population health and mortality is incredible.”
“It comes down to access – people getting these lifesaving or life prolonging medicines. We’re really striving hard on access to these.” Healthy access requires a healthy supply chain, and the UK has seen serious supply disruptions on some lines in the past few years. How well is the system working at present?
“That’s an interesting one; it ebbs and flows,” Salzmann says. “The shortages do get a lot of airtime and rightly so, because it impacts patient care and treatment continuity. But if you take the glass half full look at it, it would be maybe 15 per cent at the most – probably less than 10 per cent –that face those supply issues. The bulk are supplied as expected.
“However, I’m mindful that there have been disruptions with some medicines, and we need to manage that. My role and that of the company is to fight for access. We do everything we possibly can to avoid stock shortages, and when we do have supply disruptions, we work as quickly as we can to restore supply.”
Commentators point to a number of contributing factors, including disruptions in the supply of active molecules and sudden demand spikes leading to a rush on certain products. What does he see as the main causes?
“There isn’t just one. It’s a very complex problem, most medicines are now part of a global supply chain. Because of that, different things that happen around the world can have different impacts.
“With a lot of global organisations like ourselves, one part is made here, the next there, then it’s shipped to there to be packed and comes through us. The things that manufacturers and suppliers like ourselves would really like is having very clear understanding of what are the requirements.”
“We can talk about Brexit, we can talk about Northern Ireland and the Windsor Framework, we can talk about all of the ramifications of us leaving Europe and the uncertainty around paperwork and regulatory licensing requirements.”
The latter issue takes up time and resources on the part of manufacturers, Salzmann says, adding: “Suppliers like us are just looking for clarity around the rules.”
Some manufacturers and lobbying bodies have expressed serious concerns around the Government’s proposals to hike its clawback rates on branded medicines (branded generics and biosimilars are also included in the plans). What is the Viatris view?
“Again, it comes down to certainty and predictability – there has been a significant change in the rate we pay. We just want to work with the Government; like I say, we’ve been a key partner to the NHS for 60 years; we’ve been here for a long time and want to be here for an even longer time – to be that partner.”
“We want to work in partnership for a sustainable healthcare system. What that means to us is that we have a tax system that is stable, predictable and fair for all people who are in the sector; those are the reforms we’re looking for. We’re in the current period of consultation around the next scheme, so I prefer not to say too much other than that.”
A day in the life
What does a typical day look like for Salzmann – is it a varied role? “It is – that’s what I like about it,” he says. “My day goes from talking about supply chain logistics to HR, communications, legal and finance – you name it.
“A typical day, if I get it right, has a very good balance between internal and external. With big companies like ours, you can spend a lot of time looking internally, talking to yourselves and doing a lot of internal presentations.”
But he tries to step outside the corporate cloister and get out to talk to others, including his customers in community pharmacy: “[I want to] understand their needs, how we can help and how we are both looking to deliver on our goals,” explains Salzmann. “I strongly feel about community pharmacy that we have a strong shared purpose.”