Sugi Pharmacy x AZ Co-creation between pharmaceutical company and pharmacy!

――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.

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.

“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’.