Sugi Pharmacy x AZ
Co-creation between pharmaceutical company and pharmacy!
AstraZeneca and Sugi Pharmacy's "Healthcare Revolution" - Co-creation between pharmaceutical company and pharmacy to explore "healthcare of the future”
How should medical and healthcare industries be towards realization of “patient centricity”? In an effort to find a solution to this conundrum, i2.JP (Innovation Infusion Japan) was launched as an open community for delivering patient centricity, led by AstraZeneca, a European major pharmaceutical company.
At the time of the launch, it had a membership of seven corporations or organizations. Osaka Innovation Hub, Welby, KOBATA GAUGE MFG., Omron Healthcare, MICIN, and Sugi Pharmacy among others have joined the community in addition to AstraZeneca. Over a year since its founding, i2.JP has grown to a group of 155 companies and organizations (as of the end of January 2021), and its momentum is accelerating.
TOMORUBA has been following the multifaceted activities of i2.JP in a series of articles titled ”Challenges to Healthcare Revolution.” In this sixth installment, we take a closer look at the co-creation project between AstraZeneca and Sugi Pharmacy, an original i2.JP member from the outset. Sugi Pharmacy is a leading company in the drugstore-with- prescription-dispensary business category, operating 1462 outlets in Japan (as of the end of December 2021). Although the business was started in the Chubu region, the company is currently operating in wider areas in Kanto, Kansai, and Hokuriku regions.
So just what kind of co-creation are the two companies envisioning to challenge, being a drug developer/manufacturer and drug retailer? We interviewed four representatives from AstraZeneca and Sugi Pharmacy.
“Total Healthcare Strategy" to facilitate fusion of physical and virtual space
――First, I would like to ask you about the innovation activities at Sugi Pharmacy.
Takashi Hiruma（Hiruma）：Under the banner of “Total Healthcare Strategy”, Sugi Pharmacy focuses on activities that integrate physical and digital worlds in three domains: self-care; health/medication; and nursing care and life support.
An example is “SugiSapo Series”, which is a combination of health promotion apps and meal delivery services we design and offer in collaboration with Medpeer. Other offerings include "Lifestyle-related Disease Risk Report" that provides estimated future risks based on the results of health checkups, "Omotenashi-bin" that delivers drugs and daily necessities in package, and a mobile retail business. Under the pandemic, we started online medication guidance as well.
――You have launched quite a number of new businesses, haven't you?
Toshiro Ando（Ando）：Yes. Our focus is also on how to expand implementation of the services we have developed. For example, "SugiSapo Walk" is a pedometer app that allows users to earn mileage while enjoying a walk. We rolled out the app last year after discussing with a pharma company how it can be applied to raise disease awareness. In addition, "Lifestyle-related Disease Risk Report" is a solution designed to encourage behavioral change by grouping health checkup results by gender and age and visualizing an individual result in a ranking. Thus, we offer not only BtoC but also services for local governments, health insurance associations and corporations. Although our core business is a drugstore with prescription dispensary for consumers, we are working on developing ideas to maximize the impact of our service mix including the core business.
How pharmacy sees changes and challenges in healthcare market, being so close to patients
――Next, I would like to ask you about the trends in the healthcare industry as seen from the perspective of Sugi Pharmacy. What kind of changes are occurring around patients these days? What are the challenges?
Hiruma：Telemedicine and online medication guidance is advancing at an unprecedented speed, which we think is a major change. More patients choose not to visit the doctor due to the pandemic, which helped telemedicine and online medication guidance take root. Despite this situation, Sugi Pharmacy did not experience loss of traffic. This is because we have been opening stores within communities rather than near hospitals since its inception. Although telemedicine supports care at home, patients still need to pick up their medications. They choose to visit a nearby pharmacy in the neighborhood.
However, we are facing some challenges. We are unable to fully cover the needs of the patients in the sense that they need to come to us for medication instead of us delivering it to them. There is still room for improvement to address unmet needs for "immediate dispensing on the spot” and “access to undeliverable medications.” What to do about the last mile is an issue for us and healthcare industry alike.
――The question is what to do about “the last mile" after telemedicine and online medication guidance. What are your views on the current trends, Ando-san?
Ando：Speaking from the standpoint of a dispensing pharmacy, we pharmacists hold data such as blood test results which are shown in the medication handbook or communicated orally by patients. But these are data in “dots.” We don’t have all relevant data unlike local governments and health insurance companies do. This has traditionally been a challenge for dispensing pharmacies.
However, there are signs of a change. Online authentication and data verification is now available using My Number card, and private companies are developing Personal Health Records (PHRs). This is improving access to “lines” of data by connecting “dots.” For us, the challenge is how to make the best use of these data. In order to achieve this, early legislation is necessary. I believe that once this is done, we will be able to provide better healthcare and self-care.
In addition, drugstores hold not only data on drug purchases, but also on non-drug merchandise purchases. I am hopeful that by combining the data sets, we will be able to understand personal preferences and develop an approach that will lead to prevention and disease awareness.
――You shed light on how pharmacies can leverage data going forward. What is your take on this from the viewpoint of AstraZeneca, a pharmaceutical company?
アストラゼネカ Liu Lei（Liu）：Earlier, you talked about the last mile for patients. I think pharmaceutical companies are much further away from patients, possibly about 100 miles. With prescription drugs, contacting individual patients is only possible after following a very complex process to stay compliant. It is difficult to get real feedback from patients.
We still have some distance from pharmacists who routinely interact with patients. Therefore, we highly appreciate the opportunity to engage with pharmacists as how we have been. We are committed to being patient-centric, but after listening to Mr. Hiruma and Mr. Ando, I got the impression that Sugi Pharmacy is a few steps ahead of us. They are indeed a very powerful partner.
Hospitals, pharmacies, and pharma companies join hands to follow up with patients
――When and how did you meet each other? What made you very interested about each other, leading to the collaboration?
Hiruma：In March 2020, I was introduced to AZ through another company. At the time, our challenge was how to improve quality of our pharmacists as the government set the vision for future pharmacies. Particularly, as the responsibility of pharmacists is shifting from product handling to people services, we must consider how best we can serve people. We are also faced with the social problem of voluntary medication discontinuation. (Voluntary medication discontinuation - a patient stops taking a medication midway through the course of treatment, resulting in a poor outcome)
I believe there are four perspectives that can be employed in preventing this from happening. These are the perspectives of patients, hospitals, pharmacies, and pharmaceutical companies. These four parties are currently engaging in their own activities from their own perspectives. We wondered if it would be possible to seamlessly connect the four parties and realize an approach that can support patient follow-up throughout the dosing period.
When I was introduced to AstraZeneca, we expected we could work together to improve patients' adherence by incorporating the knowledge of the pharmaceutical company.
Ando： There is a system called "Patient Support Program" overseas, which connects patients, healthcare professionals, and pharmaceutical companies to support patient follow-up.
Contrarily, in Japan, it is not functioning well due to problems with the legal system. Forming the alliance of a pharmaceutical company and a pharmacy, we hoped to drill deeper to enable a patient support program.
――What were AstraZeneca's expectations for Sugi Pharmacy?
Ryosuke Obayashi（Obayashi）：Patient centricity is part of our vision. However, there remains significant distance between the company and patients. Sugi Pharmacy, an operator of chain pharmacies, has direct contact with patients and is close to them. Therefore, we were very passionate about forming the alliance to deepen our understanding of the patients.
――After the initial meeting in March 2020, "i2.JP" was launched in November of the same year. What was your impression of i2.JP when you heard about it?
Hiruma：We definitely wanted to be a part of it. At that time, our role was not only to research healthcare industry, but also to create new value by partnering with other industries and professions including startups. i2.JP was the ‘ticket’ we had longed for. Internal approval was granted immediately based on positive feedback.
Surveys and workshops were conducted to gain patient insights
――What kind of initiatives are the two companies currently undertaking?
Hiruma：We launched a project in response to the emerging social problem of voluntary medication discontinuation among COPD (chronic obstructive pulmonary disease) inhaler treated patients. To prevent this, we conducted a survey of Sugi Pharmacy customers to uncover their insights. Based on the results, we organized a joint workshop in February 2021. At the workshop, our pharmacists joined together to discuss how we can stop this problem.
――What were the benefits gained from holding the event jointly?
Ando： If we implement the program only by ourselves, our thinking will be biased toward "how to clear immediate issues," which will only result in realistic and analog ideas. At the joint workshop, AstraZeneca made prior arrangements in line with the policy of "allowing diverse ideas to come through" including crazy ones.
Of course, some of the ideas were realistic. But there were also a lot of excellent ideas that we hoped to advance although their feasibility were unverified. We also learned many lessons about the way workshops are carried out.
――Does AstraZeneca often conduct this kind of workshop?
Liu：Yes, we hold many workshops internally. This is because our sales planning process requires development of a patient journey for the disease area concerned. After identifying patient pain points, we set about exploring, planning, and developing solutions to address them. Going forward, we would like to increase the number of workshops involving other companies like this one.
――What kind of co-creation projects are likely to start based on the ideas from the workshop?
Hiruma：Our current offering “SugiSapo Walk” is considered for integration into a scheme to recommend early medical consultation for COPD patients. “SugiSapo Walk" is an app boasting over 2 million downloads. Users can earn mileage based on the number of steps they walk, which can then be converted into points redeemable at Sugi Pharmacy. The app challenges you to complete a “mission” daily. You are requested to answer a question such as “what is bothering you lately?” or “do you have a kind of pain described below?”
Using this function, we can encourage people at high risk of COPD to seek medical attention at an early stage, and then follow their behavioral changes. It will be nice to see successful mitigation of voluntary medication discontinuation.
――Do you think there is affinity between COPD patients and "SugiSapo Walk" users?
Liu：A typical COPD patient persona is a man in mid-70s with a long history of smoking. Based on our past experience, we are aware of the difficulty in engaging with and introducing behavioral change among these patients. So, we thought about reaching out to caregivers instead, the wife and children of the patient, which is the core of this project.
Ando：Sugi Pharmacy's main users are women in their 40s and older. They are the spouses and daughters of men in their mid-70s. We are also interested to see how effective the indirect patient approach from family members may be in promoting early medical consultation.
――I see. What did you find attractive about AstraZeneca after co-creating with them?
Hiruma：I thought the way they captured patient insights was great, let alone the patient journey. I used to think that AstraZeneca was a specialist in drugs, but in fact they are observant of people more so than we are. Also, they are very nimble in action.
“Compliance risk" stands in the way of co-creation between pharmacy and pharmaceutical company
――Were there any barriers to proceeding with the co-creation project?
Hiruma：As a pharma company and a healthcare service provider, we struggled to ensure that there was no breach of compliance - no incentives given for new prescriptions or financial gains by doing what we do. Similarly, care was necessary when we conducted a survey of patients and medical institutions.
Though both of us are aligned in the mission to maximize therapeutic benefits for patients, we were often caught up in the challenge of meeting compliance requirements, which we found a significant hurdle.
――And you are expecting the bar will be raised even higher. I would also like to ask AstraZeneca now. What are some of the struggles you had in the co-creation project?
Obayashi：As mentioned, the collaboration with Sugi Pharmacy has been carefully coordinated with our compliance team internally. Although we are aligned on the importance of meaningful collaboration between a pharma and a healthcare provider, the actual implementation requires much more care.
As a pharma company, we need to demonstrate our stance by working on an irreversible disease like COPD which is underrecognized by patients. Whenever we talk with our internal stakeholders, we bring this point to the fore.
Liu：We actually wanted to implement SugiSapo Walk-based early detection of COPD in conjunction with the World COPD Day in November. However, our internal discussion and coordination lagged on over the question of payoff to Sugi Pharmacy. As a result, we could not deliver it in time. Now that we are building an internal consensus based on solid discussions, we are making headway towards the rollout on the Breathing Day (May 9) in Japan.
Actually, there are other projects that did not materialize as a consequence of internal discussions. In fact, we were preparing to work together with Sugi Pharmacy on the issue of unused medications as a separate project. The large amount of leftover medication is a major medical and social problem facing Japan. In the patient context, the issue is about the proper use of drugs, and in the social context, it is about medical economics. Highlighted recently is the negative environmental impact unused medications could have when they are discharged into sewage systems. Someone has to pick them up for processing. A pharma company is also held accountable as a producer from the SDGs perspective.
This led us to the idea of collecting leftover medications from patients and providing professional medication guidance from pharmacists. Furthermore, we aimed to create a sustainable model by making leftover medicine bags from the collected plastic materials, distributing them to the patients, and having them regularly receive medication guidance by reviewing what is in the bags. However, there was a concern about the production cost of the bags. When we contribute a part of the production cost, we may be “shouldering” the cost to be borne by the medical professionals. A lengthy discussion ensued, after which this project was put on the shelf.
――Is that project discontinued?
Liu：Yes. However, I haven't given up. We are considering a multi-stakeholder model involving i2.JP members such as pharma companies and local governments. If AstraZeneca is the only co-owner of the project, the production cost could be considered as a payoff to Sugi Pharmacy. If so, we can work with others to make the project open and neutral. So, I will try once again. The underlying problem is still there, but the internal and external stakeholders agreed in principle on the bottleneck to be removed. We believe that all we need to do is figure out ‘how’.
Hiruma：We took the matter of leftover medications beyond our company as social agenda as the country’s social security expenses keep climbing. We were very disappointed when the discussion was suspended.
Ando：Actually, leftover medications are significantly influenced by medication adherence, which I mentioned at the beginning. Pharmacists check with patients to see if they are taking their medication or if they have any extra, but sometimes they do not tell the truth, even to the doctor. The doctor would then make the decision to add more medication because symptoms are getting worse with the current level of medication. In other words, drugs are being overprescribed.
Therefore, we would like to know if the patient is taking medications properly so that we can provide appropriate support. We can recognize it by having patients bring the remaining doses to us. We believe that this will drive the right support for patients.
――How should we drive innovation without running compliance risk?
Liu：Compliance is of course a given. However, new initiatives often have no precedent, and generally there is no materials to clearly identify the risks. This is a situation that you will naturally face when you are working on a novel business, and there is no panacea. We believe that careful communication is important. We should cautiously discuss possible risks on various fronts including compliance, with the relevant departments within the company. If we can all agree on implementation, then we can proceed in unison. Another point I would like to emphasize is that "innovation is not produced without taking any risks.” I believe Japanese healthcare industry is a staunch believer of ‘no risk.’ Though challenges remain for changing this mindset immediately, it is important to work in an agile manner, accumulate successful experiences, and share them with industries and society.
Vision for "i2.JP" beyond co-creation between pharmacy and pharmaceutical company
――What are your prospects for future?
Liu：I would like to work more deeply with pharmacists, who have physical touch points with patients in order to understand their pain points better. If the first line of defense is doctors and nurses in hospitals, then the second line of defense is pharmacies and pharmacists, responsible for informing patients.
Once this second line of defense is crossed, the next level down is home caregivers (e.g., family members). But these caregivers are not experts. In that sense, pharmacists contribute expertise in the last line of defense. Therefore, I would like to promote collaboration with pharmacists from various perspectives.
Hiruma：We are currently working in the area of COPD, but I believe that we can make similar efforts in other areas such as oncology.
In addition, we are interested in collaborating with companies participating in i2.JP to work on side effects detection and others. I think that we should actively set up more trials so both of us can gather knowledge to ultimately benefit patients.
――What are your final message to those who are considering being part of “i2.JP”?
Hiruma：Even if you are not a healthcare specialist, if you have a technology that can be used in healthcare, there are many opportunities at i2.JP. Those who are joining i2.JP are encouraged to bring with them a spirit of “just do it” rather than a defeatist attitude. Through repeated trial and error, we can work together to solve problems in the healthcare field and create practical and optimal solutions through collective knowledge.
If hospitals, pharmacies, and pharmaceutical companies are seamlessly connected and work together to detect diseases at an early stage and maximize the effectiveness of treatment, it may contribute to delivery of better medical and healthcare services. On the other hand, in order to maintain the soundness of the industry, some degree of regulatory rigor is necessary. However, excessive regulatory requirements could hinder innovation. Further discussion are necessary on how to optimize the deregulation.
i2.JP offers opportunities for business matching and discussions. If you are a company or organization with the commitment to having dialogue to chart a course toward patient centricity, please visit i2.JP. please contact us
(Editor: Yukitake Sanada, Writer: Wakako Hayashi, Photographer: Hidenori Maede)
- Lei Liu ※joined virtually
- Director, Innovation Partnerships & i2.JP, Commercial Excellence, AstraZeneca K.K.
Joined GE Healthcare Japan as a new graduate. Engaged in medical devices R&D and joint research with universities. Moved to the Japan Research Institute Ltd., where he was in charge of organizing and promoting a consortium on the themes of autonomous driving and frailty. After working for startups and a life insurance company, he joined AstraZeneca K.K. in January 2020. Since then, he has led the launch and operation of i2.JP.
- Ryosuke Obayashi
- Program Lead, Innovation Partnerships & i2.JP, Commercial Excellence, AstraZeneca K.K.
After graduating, he joined a pharmaceutical company specializing in diagnostic imaging products. Worked as MR in charge of Tokai area. He then moved to assume a business development position in R&D, where he was engaged in forming alliances with other pharmaceutical companies and licensing with overseas bio startups. After being transferring to the New Business Promotion Department/IT Solution Department, he was involved in launching AI-DX software facilities and building operations for cloud-based diagnostic imaging software. In April 2021, he moved to AstraZeneca K.K., where he is in charge of operating "i2.JP" with Mr. Liu.
- Takashi Hiruma (Pharmacist)
- Medical and Dispensing Business Reform Section, Medical and Dispensing DX Promotion Department, Sugi Pharmacy
Joined Sugi Pharmacy in 2006. Appointed as a drugstore manager In 2008. Served as Dispensing Unit Area Manager for ten years from 2009. Moved to Corporate Planning team, where he was responsible for Total Healthcare Strategy. Current position since 2021.
- Toshiro Ando (Pharmacist)
- Medical and Dispensing Business Reform Section, Medical and Dispensing DX Promotion Department, Sugi Pharmacy
Joined Sugi Pharmacy in 2011, after working for a hospital. In 2013, he became Area Manager of the Dispensing Unit and went on to become a Sales Manager. In 2019, he moved to Corporate Planning team, where he was responsible for the company's new business. During his tenure, he initiated collaboration with pharmaceutical companies. Current position since 2021.
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