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EF: How many years have you been working with generics?
TS: The Law is from 1999, we are 23 years old and PróGenéricos is 22. It was created practically at the same time with also Anvisa, our Health Surveillance Agency. So the period of existence is the same.
During these 23 years, we managed to provide important and consistent access to the population. We now have 35% of the retail market. If we have institutional sales to the Government, for example, we get close to 50%.
PróGenéricos represents companies that manufacture generics and biosimilars – which is another way to expand access to low-cost molecules. By maintaining this policy, access to quality, efficacy, safety and lower product prices is expanded.
Our 15 companies represent 90% of the generics market and these companies operate in the segments of reference drugs, generics, biosimilars and similar ones, which are the generics that have a brand here in Brazil.
In this sense, we can say that we generate not only access for people throughout the health system but also savings for the country. Today we have all the necessary molecules for the treatment of the most known and prevalent diseases.
90% of the diseases that most affect the Brazilian population can be treated with generics. If they do not participate directly in the treatment of a specific disease, they can act as adjuvants. For example, in the case of the Covid-19 pandemic, we still don't have a remedy or treatment for this issue because it is a new situation where there cannot be all kinds of tests. So, it was the generics that were able to provide support at that time in all countries.
When the vaccine appeared, it could act in prevention. But before that, always with the help of paracetamol, dipyrone, intubation drugs, fever and other symptoms were treated with generic drugs. With this, the entire population can have access.
During this period of the pandemic, we were in constant communication with the government and health surveillance so that we could help overcome this difficult period by making our companies available. Eurofarma is our associate. Crystal is not. But, I am on the advice of another entity, which is ABIFINA, which takes care of the fine chemistry of APIs and Cristália is present there.
With these challenges of scarcity that we had of offers and inputs from the IFAS, we had a very large increase in international costs. And Brazil had no shortage of products on the market. There was a great effort by the Industry to not run out of drugs on the market. There was also an important effort by Anvisa to create regulations that could help us overcome obstacles we had at that time, promoting flexibility without sacrificing quality.
With this solidarity and empathetic support, the barrier of capitalism was overcome by making prices more flexible, the new laws established, the sensitivity on the part of drug producers, importers, the legislature in parliament, the executive and the judiciary.
So, the role of generics during the pandemic was very important – not only in Brazil but worldwide.
And it remains so because health savings are needed even in the richest countries. Even in the US, for example, savings are needed to promote access to the greatest number of people and generics fulfil this role very well by optimizing costs.
I've been at PróGenéricos for 10 years and in my professional career I've been in pharmacy, distribution, industry and today I'm at PróGenéricos, at the institution that is a way of putting all these links together and being able to work. I am very proud to work here! A place that manages to open paths.
10 years ago we had 26% of the market. Today, as I said, we have 35% in the Retail Market and almost 50% in the total market. So we managed to grow. Industries today have grown and strengthened a lot with generics. For a company like Eurofarma, for example, an important part of its business is generics. Companies like EMS, sometimes 40% to 50% of these companies business comes from generics. Sanofi has Medley and Novartis has Sandoz as an important part of generics.
And this growth was due to the improvement of sanitary norms, and the institutional mechanisms of this market and, we can say that we participated in the construction of this generics market for having been at the forefront of all these dialogues. Last year we had an important change in the Patent Law because in Brazil we had a very long time to analyze a patent, which could last up to about 35 years – since the law guaranteed that it would have at least 10 years after being granted.
With the change, a patent will have 20 years from the moment of the application equally to other countries. This makes us have a patent market that is healthy for generics, as it allows industries to work with the forecast launch of products at a given time, making it possible for the population to have constant access to medicines. In the year 2021, we had this victory.
In the period of the pandemic with Covid-19, it also made us reflect on the importance of vaccination and something that caught our attention was about countries having autonomy and innovation because some countries were hostages of other countries and many are still in this condition. In Brazil, with the support of partnerships, research and tests are already being carried out for our own vaccine production.
During this period of covid, the population also had to postpone going to hospitals to carry out their treatments and routine exams, since Covid took the place of other diseases. This year we returned to taking care of people's basic health with continuous and preventive treatments. So generics are important in the treatment of chronic diseases. We grew a lot, but we identified that in some molecules we lost space because people went to take care of their illnesses during this period and left conservative treatments aside.
If we want to avoid new collapses in public health, we need to guarantee preventive treatments so that people can have their health well taken care of, and in this regard, generics play an important role.
The priority of PróGenéricos' work agenda is to improve sanitary regulations, always to match world standards, and to understand the difficulties of a country with a smaller economy. We do not want to repeat models that may be very suitable, but not for this moment. We have to have the intelligence to use the resources for whatever is necessary. So, we also need to encourage the improvement of the National Institute of Patents so that it can continue to analyze patent applications because we are dependent on these patent applications to expand access. And today, worldwide, the number of discoveries has been decreasing. And when there are discoveries, it comes at a very high cost! That's why the importance of taking care of health in a preventive way because taking care of health is getting more and more expensive.
Since they arrived in Brazil, the market for generics and biosimilars has brought savings of more than 200 billion reais to the population and the government. If this is converted into dollars, it means savings of more than 40 billion dollars for the population, allowing the expansion of the treatment of their diseases by investing in the purchase of more medicines that allow for complete and correct treatment.
By law, generics cost 35% less than the reference drug. We still work with very high discounts because the competition is very strong. To remain in the market, better and better prices are needed. With that, generics are price modulators because the population can choose what has the best offer.
Generics also grow more than the total market. When the total market grows 4% we grow 6%, when it grows 8% we grow 15%. So we pull the total market sale.
In the case of biosimilars, the same phenomenon is happening. The more biosimilars we have on the market, the more the price of the reference medicine drops. Allowing people to have access to treatments for more complex diseases that were previously impossible to access, as treatments were very expensive.
Brazil has been struggling for some years to implement partnerships for product development known as PDPs. This program concentrates government purchases with a triad of partnerships that is the private sector, the public company of national laboratories and the government. So, you can transfer technology, and improve mechanisms, but also offer products to the government that will be aimed at the population and at lower prices.
So looking to the future I'm sure generics will be what they are in the US, and in Germany; understanding that we treat health in a different way. Health payments in Brazil are different from those in other countries. But we still have a lot of room for growth because we will have more companies in this market. So, the PDP policy is a correct policy that has to continue and that will allow Brazil to absorb more technology. The companies that emerged because of generics are now dedicated to both radical and incremental innovation, improving existing products and transforming this market.
The lesson is that Brazil has the capacity to play the global game. We have a strong pharmaceutical industry, skilled labour, research, universities, development, and experienced entrepreneurs. In the pandemic, we didn't close companies, we didn't have a drop in productivity; we have scientists and creativity. So we are sure that Brazil will continue to be a major player in the international market. Generics are proof that Brazil is capable of building powerful industries in the market.
In 2021 we sold close to 2 billion units, a growth of 6 % and our revenue was also close to 15 billion reais.
There are approximately 93 companies that manufacture generics in Brazil and we have a very significant market.
So, we are hopeful now that in 2023 – based on this supreme decision – brought the patents to the right time to launch products for HIV, diabetes, anorexia, leukaemia, cancer, hyperplasia, hepatitis and rheumatoid arthritis. So, we are sure that we will continue to grow a lot.
EF: What does access mean to you? What is the definition of access for you?
For the market in which we work, access is when you give the population the opportunity to choose the treatment they need. By having the medicine at the time and moment that it is needed to cure the disease and making it available at a low cost on the market, the government may have the possibility of obtaining these medicines to offer for free to the population. In Brazil, there is a program known as the "popular pharmacy" that provides free medication for diseases such as hypertension, diabetes and cholesterol. That's because these diseases are the ones that most affect the world's population and that, if not treated, will generate other much bigger diseases.
So when we saw the diabetes drug market increase by almost 2,000%, it means not only that the industry sold a lot, but many people were able to treat themselves and allocate a resource that they previously needed to invest in a very expensive drug to eat well, put children in school and have adequate housing. We live in a country with a very restricted economy, if in the area of health we make our contribution to promoting medicines with lower prices and quality, and then we allow access to health equality for all. That's access!
EF: Regarding Brazil's elections in the future, what advice can you give the new administration on the importance of health within the post-pandemic economy?
First, you don't forget the lesson learned from the pandemic in all aspects. Let it be dedicated to understanding that health is the greatest good of the human being. There is no evolution and economic growth of any kind if people are not healthy. We need to develop state policies that are stable and that continue to be government-to-government. Those policies only improve and be thought of by the citizen so that people have the assurance that they will have that access.
For that, we have to invest in our companies, have equality and not allow the country to be hostage to others. We have to invest in technology and science in Brazil so that we can be exporters to other countries that don't have the same capacity. But for that, we need to take care of our country and the people who make it up to be able to offer this. It's more or less like your home. You take care of yourself so they can't cause trouble for others. This is already a big contribution and if they can offer solutions, even better! So, we have to take care of ourselves so that our illnesses don't get worse and offer solutions. And that's technology. It is investing in innovation, in a stable market, with legal predictability, with an improvement of standards, but always understanding the reality of our country and seeking to make sure that we can change this reality for the better, always!
We cannot leave education out of the way. The country has to worry that everything is interconnected. People who access health have access to education. Those who are well-educated can work and access medication; understand that there are forms of treatment.
We need a leader who inspires us and looks at the Brazilian people with affection, seeking equality, bringing excellent universities to produce quality science, good medicines, cutting-edge education and a growing economy. My mother used to say something important: “It's not just about having money; it's about thriving." Brazil needs to prosper.
EF: In 5 or 10 years, when you look back and remember this moment within PróGenérica – living through a pandemic, coming out of the pandemic – how would you like to remember this moment?
TS: I would like to look back and remember that moment as a moment of evolution and inspiration. Because we evolved despite the problems; we learn. I feel better today than 3 years ago because I felt able to deal with so many problems, to live in the moment [which is a moment we suffer], but we knew how to work with it. I've lost family members to Covid, but we've learned a lot. I will remember this time as a time of spiritual and material evolution.
We learn to value and use our money. What we earn, we invest and what we have. Health is the greatest asset we have. Bags, shoes, and trips are good, but they are expendable. We need to have physical and mental health. So, I feel victorious for having gone through this period in good health, helping people with my work through interventions, meetings with the government and my ministers, and seeking ways for health to cope with this moment. And that's why I feel like a better person because I managed to overcome it and I learned that I should know more. Because if I had known more I could have helped more. So, it is a moment that also inspires us to think outside the box and that we can always be better because problems always lead us to prosper and evolve as people.
Putting our dreams into dignified things! Sometimes we put our dreams into small things. But I do believe that we have to come out of this moment inspired to be better people and to be more willing to help and science calls us a lot to do that. We can study more, we can do more, and we can discover other ways to strengthen ourselves as people and also to strengthen ourselves as increasingly better professionals.
