[EN] - Beyond price: why Europe must rescue its essential medicines

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Essential medicines are a matter of production,

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profitability,

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and EU sovereignty.

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We often talk about access in terms of price,

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but access also depends on the availability of mature medicines.

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These mature medicines have low margins and global supply chains that are fragile.

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Karine Pignon defends a simple idea,

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production must remain economically viable in Europe.

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Since this interview,

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she has created a trade association to defend local pharmaceutical production.

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It's not just an industrial issue,

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it's a matter of sovereignty.

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To me,

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they are essential.

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During the COVID period,

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we had zero production delays.

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It means that those guys,

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despite the fact that people were dying everywhere,

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in every neighborhood,

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they kept going and producing.

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I still get chills.

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I tell myself there are people who risk their lives to go and produce.

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This episode was recorded with the support of LXO and MedFrance.

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Hello everyone,

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welcome to this new episode of PharmaMind.

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Thank you dear listeners for being more and more numerous to follow these episodes.

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Today we are hosting a woman who is shaking up the codes of pharma.

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We are hosting Karine Pinon.

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Hello Karine.

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Hello.

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Karine is the CEO and founder of Exo Laboratories and we're going to dive into a fascinating journey,

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the creation of a pharmaceutical laboratory that defends French production and European production and mature medicines.

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So.

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I think it's going to be a great example to show that you can be an entrepreneur in pharma and succeed while remaining authentic and committed.

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A vast program.

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It's a vast and ambitious program.

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So you begin with just two molecules,

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right?

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Then you say,

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OK,

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let's move on to mature products.

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Is it?

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Yeah.

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So why mature products?

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Yes,

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because in fact,

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it's true that in pharma,

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we tend to stick to,

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let's say,

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talking mostly about innovation because that's what shines,

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actually.

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And it's true that personally,

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we're delighted to have innovative products.

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And that's what makes the news.

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Now,

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when we look a bit at what French people consume,

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that is to say,

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in their everyday chronic pathologies,

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95%

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of the time,

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French people take mature products that are sometimes genericized,

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sometimes not.

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So why aren't they genericized?

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Sometimes because they are purely French products.

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So in fact,

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the generic manufacturer says there's not much interest because there's not much volume.

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Generic equals low price.

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So if you don't make much margin necessarily,

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there needs to be more volume to make more money.

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It's a bit mathematical.

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And so as a result,

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these mature products,

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which are often called essential products or MITM,

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major therapeutic interest medicines,

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these drugs make up the daily life of French people for pathologies like diabetes,

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hypertension,

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including

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CNS pathologies,

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the central nervous system,

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everything like antidepressants and so on.

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All of that and the majority consists of mature products at 95%.

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These mature products,

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which will also be responsible for the significant increase in life expectancy.

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Today,

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if we reach 90 years old,

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it's because cardiovascular issues are managed,

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diabetes is managed,

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etc.

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So these products have a definite interest.

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And then for big pharma,

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they say to themselves,

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I have to do R&D.

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So I'm looking for blockbusters.

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And so as a result,

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I have less interest in these mature products,

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which means that effectively they're going to divest themselves of these mature products because they are products that take time.

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And so they want to focus on blockbusters.

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That's why we must never pit the two models against each other.

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There are two different models that need one another.

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Big Pharma needs these companies that keep mature products alive because that's what sustains one's...

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Again,

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95%

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of pathologies.

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And they also fund,

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in a way,

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a bit of their innovation,

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because when we buy them,

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we buy them at a high price.

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And so it's money they reinvest into R&D.

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So the two models aren't in opposition,

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but we're at different stages of the molecule's life cycle management.

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So these mature products,

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to me,

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they are essential.

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And then it's a bit like the same trend we see,

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I don't know,

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with clothes.

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You see,

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with clothes,

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people say...

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we have to stop systematically buying new clothes and so on.

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Secondhand items also have their own value.

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I don't mean to say a mature product is secondhand,

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but in a way,

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why look for something new,

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something innovative that will inevitably be more expensive if we can treat things the same way with products that are certainly less innovative,

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but they get the job done.

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So from a citizen's perspective,

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it's very interesting because we couldn't you

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afford it if we were all paying 1,000 euros a box to treat hypertension.

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The economy wouldn't survive.

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It's already struggling enough today,

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but that would be terrible.

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So that's really it.

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It's saying it's okay to have a Ferrari when you have a cancer that's super complicated.

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and so on.

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But if in the end,

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the Megane or the Laguna gets you there and does its job,

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why pay so much?

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So really these mature products,

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that's how my interest in them comes about,

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right?

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And there you go.

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Yeah.

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Okay.

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So you're saying these are in fact medicines that have a significant and important place in the healthcare system and not sufficiently valued.

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Is that right?

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I got into these mature products,

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not by chance as it happens,

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because that's what I'd done at Proctor

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And then very quickly,

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I came across an association called MedFrance,

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which is the association that represents SMEs.

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And so

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I realized that,

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well,

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I joined just as a board member and so on.

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And I realized just how many SMEs there are doing the same thing and fighting for the recognition of this French production,

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while also highlighting that these mature products,

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which have often faced price cuts because it was you

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the logic of the CEPS,

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the Economic Committee,

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to lower prices to keep social security profitable.

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In fact,

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we've reached such a low point.

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In terms of profitability,

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sometimes these mature products are no longer profitable.

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All right.

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Do you have an example of products like that?

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Well,

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there are plenty.

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There are plenty.

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One thing you need to understand is that successive price drops mean that little by little,

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we reach the bottom of the margin level.

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So I...

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I had a product called Theraline where we were at 89 cents for 50 tablets.

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And it became all the more crazy because

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89 cents for 50 tablets.

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So we're not even at the price of a baguette,

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right?

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Let's be clear.

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When inflation hits,

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we get to roughly between 20 and 25 percent increase in manufacturing costs because electricity is more expensive.

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Aluminum is more expensive.

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Everything is more expensive.

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And in fact,

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that's where you see that the whole thing becomes completely crazy.

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That is to say,

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the price of the medicine stays the same.

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The margin continues to decrease.

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And so,

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in fact,

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my manufacturer who was in France was losing money.

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My API manufacturer was losing money every time they produced the product.

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In the end,

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we're out of stock.

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And I'm liable to get penalties,

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fines,

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because I'm out of stock.

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And all that to complete the picture is that this product counts.

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towards my turnover,

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even if I make zero margin or even I was losing at the time more than 20 cents per box sold.

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It counts towards my turnover.

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So I'm going to pay the safeguard clause on this turnover,

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which is penalizing for me.

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So that's where we get to something totally heretical.

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And so as a result,

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in this case,

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I finally got a price increase,

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but three years later.

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So it took,

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that's where very small companies.

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They don't have the necessary cash flow to be able to deal with that.

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Me now,

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today,

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I have 80 million euros in turnovers.

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So naturally,

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I see the future a bit more clearly,

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but very small businesses can't operate in it.

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That's why we at MedFrance are really trying to support them,

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to bring them to the forefront of these extreme situations,

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to highlight them and tell them that it's not okay for us to lose our margin.

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Because in most government minds,

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and so on,

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they think,

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yes,

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but it's okay because they make the margin on other products.

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That's the case when you're talking about Sanofi.

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There you go.

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You're a big player.

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You have innovative products,

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mature products.

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You can actually afford to have products where you make less margin.

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But when you're just a small company,

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an SME making 10,

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15 million euros in turnover,

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but with products that all have the same characteristic,

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they're low price products.

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So yes,

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it's a problem.

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We're really working on this at MedFrance to try to make people understand that while we say health is priceless,

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medicine does have a cost.

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Because yes,

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0.89 to produce 50 tablets,

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all of that has costs and it can't just come out to 0.89.

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It's just mathematics,

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especially if you manufacture in France,

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because we mustn't forget that manufacturing in France necessarily costs more than manufacturing in very distant countries.

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Yeah,

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I have 10,000 questions coming to mind right now.

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The first one is just an example to show what type of products are there.

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Actually,

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are there immature products?

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Yeah,

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sure.

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Well,

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then you mentioned,

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for example,

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vitamin K.

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Yes,

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well,

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I mentioned vitamin K because there it's even more critical for vitamin K.

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So here we're talking about products used in intensive care.

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We're dealing with products that are sterile and so on.

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So you imagine the little vial.

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So there you go.

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And I think we're at less than one euro for vitamin K.

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And so as a result,

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there are only SMEs left today that manufacture vitamin K in France.

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It's a very small volume,

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very small volume and very,

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very unprofitable.

273
00:10:09.708 --> 00:10:10.509
And when there were,

274
00:10:10.629 --> 00:10:11.309
after COVID,

275
00:10:11.429 --> 00:10:13.110
all the problems we had with glass,

276
00:10:13.971 --> 00:10:17.013
glass really very significantly increased.

277
00:10:17.233 --> 00:10:18.354
We were at great risk,

278
00:10:18.674 --> 00:10:20.295
hence the famous health sovereignty.

279
00:10:20.776 --> 00:10:22.937
And what's a shame is that this health sovereignty,

280
00:10:23.057 --> 00:10:26.760
which was so important post-COVID today,

281
00:10:27.200 --> 00:10:29.402
we are already starting to forget it.

282
00:10:31.043 --> 00:10:32.664
And when you created this lab,

283
00:10:32.884 --> 00:10:34.165
were there already labs for...

284
00:10:34.905 --> 00:10:35.586
100%

285
00:10:35.646 --> 00:10:36.927
mature products that existed?

286
00:10:37.507 --> 00:10:37.667
Well,

287
00:10:38.047 --> 00:10:38.228
yes,

288
00:10:38.229 --> 00:10:38.648
in France,

289
00:10:38.688 --> 00:10:38.888
yes.

290
00:10:39.308 --> 00:10:40.269
There was one in Lyon,

291
00:10:41.070 --> 00:10:42.571
but there were others elsewhere.

292
00:10:42.931 --> 00:10:43.471
In Germany,

293
00:10:43.551 --> 00:10:43.992
notably,

294
00:10:44.332 --> 00:10:46.293
there's a huge one that has snapped up many,

295
00:10:46.394 --> 00:10:47.514
many mature products.

296
00:10:48.975 --> 00:10:50.056
There are some in England too.

297
00:10:50.517 --> 00:10:50.657
Well,

298
00:10:50.817 --> 00:10:51.918
they're pretty much everywhere,

299
00:10:52.398 --> 00:10:52.778
I'd say,

300
00:10:53.599 --> 00:10:54.499
in various countries.

301
00:10:54.860 --> 00:10:55.400
In France,

302
00:10:55.980 --> 00:10:57.742
we have two that are quite significant.

303
00:10:58.102 --> 00:10:59.823
And then there are lots of small ones.

304
00:11:00.124 --> 00:11:00.464
Today,

305
00:11:00.824 --> 00:11:01.585
at MedFrance,

306
00:11:01.665 --> 00:11:01.785
we...

307
00:11:02.229 --> 00:11:06.732
We have a scope of about 136 companies.

308
00:11:07.112 --> 00:11:10.694
So with scopes in terms of turnover that are very different,

309
00:11:11.474 --> 00:11:12.435
it can range from,

310
00:11:12.875 --> 00:11:13.275
I'd say,

311
00:11:13.756 --> 00:11:15.917
barely 1 million to several,

312
00:11:16.077 --> 00:11:16.217
well,

313
00:11:16.218 --> 00:11:17.198
up to 150,

314
00:11:17.278 --> 00:11:17.718
200,

315
00:11:17.758 --> 00:11:18.518
300 million,

316
00:11:18.619 --> 00:11:18.859
you know,

317
00:11:19.199 --> 00:11:19.419
right?

318
00:11:19.799 --> 00:11:22.921
So we have this characteristic where 65%

319
00:11:23.341 --> 00:11:28.444
are mature products and we mostly target the French territory.

320
00:11:28.804 --> 00:11:29.525
That is to say...

321
00:11:29.865 --> 00:11:30.525
when you look at it,

322
00:11:30.585 --> 00:11:31.526
about 70%

323
00:11:32.226 --> 00:11:36.369
of everything that comes out of our SMEs is destined for the

324
00:11:37.029 --> 00:11:37.850
French territory.

325
00:11:38.170 --> 00:11:38.770
In SMEs,

326
00:11:38.771 --> 00:11:41.852
we mostly talk about mature products that aren't genericized,

327
00:11:41.853 --> 00:11:43.713
so they still have a certain specificity.

328
00:11:44.414 --> 00:11:47.075
The bulk of mature products are genericized though,

329
00:11:47.415 --> 00:11:47.695
right?

330
00:11:47.936 --> 00:11:48.936
So behind that,

331
00:11:49.917 --> 00:11:51.137
so there are alternatives.

332
00:11:51.217 --> 00:11:53.299
But as we can clearly see,

333
00:11:53.759 --> 00:11:54.740
when there was a problem,

334
00:11:54.800 --> 00:11:55.580
for example,

335
00:11:55.980 --> 00:11:56.921
with amoxicillin,

336
00:11:57.041 --> 00:11:57.161
well...

337
00:11:57.341 --> 00:11:59.802
all the amoxicillin generics had the same problem.

338
00:12:00.103 --> 00:12:03.504
So that's where you have to look to see where the problem comes from.

339
00:12:03.905 --> 00:12:07.827
And then often people tell you it's a problem that is multifactorial.

340
00:12:08.107 --> 00:12:11.068
But the multifactorial usually has a common denominator,

341
00:12:11.128 --> 00:12:12.649
which is the economic balance,

342
00:12:13.029 --> 00:12:16.631
meaning that if you have an economic balance that is broken,

343
00:12:16.912 --> 00:12:17.052
well,

344
00:12:17.092 --> 00:12:17.452
indeed,

345
00:12:17.632 --> 00:12:21.054
all the elements of the chain are in difficulty.

346
00:12:21.274 --> 00:12:26.697
And so the fact of giving a real price back to medicines allows for rebalancing.

347
00:12:27.113 --> 00:12:27.953
In my example,

348
00:12:27.973 --> 00:12:30.855
we decided to share the price increase with our CDMO,

349
00:12:31.175 --> 00:12:32.095
our manufacturer.

350
00:12:32.636 --> 00:12:33.476
So in fact,

351
00:12:33.836 --> 00:12:38.838
we ensure that every time they deliver the quantities necessary for market consumption,

352
00:12:39.639 --> 00:12:43.100
we compensate them in a higher way,

353
00:12:43.480 --> 00:12:43.701
right?

354
00:12:43.821 --> 00:12:46.462
To try precisely because it's a commitment,

355
00:12:46.562 --> 00:12:47.462
this price increase,

356
00:12:47.482 --> 00:12:48.983
we weren't just giving it,

357
00:12:49.643 --> 00:12:49.923
you know,

358
00:12:49.983 --> 00:12:51.064
it's not a blank check,

359
00:12:51.164 --> 00:12:51.364
right?

360
00:12:51.404 --> 00:12:53.465
It's not a gold card they pulled out for us.

361
00:12:53.877 --> 00:12:57.200
We were told price increase if there is compliance and no shortages.

362
00:12:57.661 --> 00:12:59.082
So as a result,

363
00:12:59.182 --> 00:13:02.926
it's a mutual commitment that we have and fair compensation allows for that.

364
00:13:03.847 --> 00:13:05.168
Stockouts from the legal angle?

365
00:13:05.528 --> 00:13:05.768
Yes.

366
00:13:06.309 --> 00:13:07.490
So I imagine it's contractual.

367
00:13:07.610 --> 00:13:08.511
It becomes contractual.

368
00:13:08.831 --> 00:13:09.052
Yes,

369
00:13:09.172 --> 00:13:09.732
absolutely.

370
00:13:10.133 --> 00:13:11.033
It's contractual.

371
00:13:12.074 --> 00:13:12.835
And beyond that,

372
00:13:13.075 --> 00:13:13.956
you should know that,

373
00:13:14.016 --> 00:13:14.176
well,

374
00:13:14.256 --> 00:13:18.901
any stockout must be reported on TrustMed and so on.

375
00:13:19.281 --> 00:13:19.501
Anyway,

376
00:13:19.541 --> 00:13:21.003
there are things that are extremely well,

377
00:13:21.163 --> 00:13:21.503
I'd say,

378
00:13:22.043 --> 00:13:22.564
mapped out.

379
00:13:22.884 --> 00:13:23.885
But these shortages,

380
00:13:23.945 --> 00:13:24.285
they have,

381
00:13:24.506 --> 00:13:25.346
once again,

382
00:13:25.647 --> 00:13:26.647
often a common point,

383
00:13:26.648 --> 00:13:27.708
a common denominator,

384
00:13:28.029 --> 00:13:32.773
because even if it affects at some point different actors in the chain,

385
00:13:33.093 --> 00:13:35.215
often the driver is still economic.

386
00:13:35.655 --> 00:13:36.216
And besides,

387
00:13:36.236 --> 00:13:38.538
the proof is that at the dispensing level,

388
00:13:38.818 --> 00:13:40.880
this is what's absolutely crazy in France,

389
00:13:41.180 --> 00:13:43.322
is that at the dispensing level,

390
00:13:43.682 --> 00:13:46.925
we managed to say we're going to pay a pharmacist one euro.

391
00:13:47.265 --> 00:13:49.026
euro zero two per box delivered,

392
00:13:49.386 --> 00:13:50.147
which is really good.

393
00:13:50.347 --> 00:13:51.367
I have no problem with that.

394
00:13:51.748 --> 00:14:01.393
But so one euro zero two per box delivered means that the pharmacist has one euro zero two net margin on the box delivered.

395
00:14:01.774 --> 00:14:02.534
And behind that,

396
00:14:02.654 --> 00:14:07.277
we aren't able at the manufacturer or operator level to guarantee a minimum margin.

397
00:14:07.617 --> 00:14:08.858
And until we have that,

398
00:14:09.018 --> 00:14:14.241
until we've actually decided what the minimum margin is that we should make on a medication.

399
00:14:14.577 --> 00:14:14.777
Well,

400
00:14:14.857 --> 00:14:15.838
then after that,

401
00:14:15.918 --> 00:14:17.059
it's just not possible,

402
00:14:17.099 --> 00:14:17.399
you know.

403
00:14:17.819 --> 00:14:19.300
Are these discussions you're having right now?

404
00:14:19.561 --> 00:14:20.981
These are discussions we're having.

405
00:14:21.182 --> 00:14:23.363
So we're having some very interesting discussions.

406
00:14:23.743 --> 00:14:27.806
So obviously the DGE and BERSI are quite open to the subject.

407
00:14:28.166 --> 00:14:28.707
Afterwards,

408
00:14:28.767 --> 00:14:32.750
what's very complicated is that when we talk about a minimum margin on a tablet,

409
00:14:32.810 --> 00:14:34.871
it's not the same as on a sachet.

410
00:14:34.872 --> 00:14:37.653
It's not the same as on an ampoule for injection.

411
00:14:38.033 --> 00:14:39.354
So as a result,

412
00:14:39.634 --> 00:14:40.275
all of this is,

413
00:14:40.475 --> 00:14:41.776
it requires a lot of things,

414
00:14:41.796 --> 00:14:43.297
a lot of discussions and so on.

415
00:14:43.693 --> 00:14:45.735
The administration doesn't move very fast either,

416
00:14:45.796 --> 00:14:46.496
let's be honest.

417
00:14:46.536 --> 00:14:47.437
But in any case,

418
00:14:48.378 --> 00:14:55.126
there are people who understand that you can't treat a big farmer and SMEs the same way from a tax or reporting perspective.

419
00:14:56.087 --> 00:14:56.207
Well,

420
00:14:56.307 --> 00:14:57.148
that's understandable,

421
00:14:57.468 --> 00:14:57.729
I see.

422
00:14:58.890 --> 00:14:59.931
So at MedFrance,

423
00:15:00.312 --> 00:15:03.896
our goal is precisely to help these companies promote their production,

424
00:15:03.976 --> 00:15:05.077
especially if it's French.

425
00:15:06.341 --> 00:15:08.262
Then we have a second point,

426
00:15:08.722 --> 00:15:10.683
which is to be more transparent with the patient.

427
00:15:11.644 --> 00:15:14.486
And I think the pharmaceutical industry lacks transparency.

428
00:15:15.506 --> 00:15:17.007
That's something that always frightens me.

429
00:15:17.227 --> 00:15:18.808
And just to finish on the previous topic,

430
00:15:18.928 --> 00:15:20.349
it's that as a result,

431
00:15:20.509 --> 00:15:24.791
you're asking for things to achieve a certain level of margin.

432
00:15:25.271 --> 00:15:26.392
And the big pharma companies,

433
00:15:26.452 --> 00:15:26.632
which,

434
00:15:26.712 --> 00:15:27.273
for example,

435
00:15:27.313 --> 00:15:30.734
have a balancing capacity because there's innovation,

436
00:15:30.774 --> 00:15:31.315
does that mean,

437
00:15:31.615 --> 00:15:31.995
in fact,

438
00:15:32.015 --> 00:15:33.236
they should be treated differently?

439
00:15:33.836 --> 00:15:34.096
Today,

440
00:15:34.116 --> 00:15:35.157
we simply do not know.

441
00:15:35.661 --> 00:15:35.901
Today,

442
00:15:35.941 --> 00:15:36.982
they're not treated differently.

443
00:15:37.343 --> 00:15:37.643
Today,

444
00:15:37.883 --> 00:15:40.605
we still don't know how to finance the innovations that are coming,

445
00:15:40.865 --> 00:15:41.466
because indeed,

446
00:15:41.526 --> 00:15:43.668
we're all glad if we have cancer,

447
00:15:43.708 --> 00:15:44.609
if we have an illness,

448
00:15:44.669 --> 00:15:44.809
etc.,

449
00:15:45.189 --> 00:15:46.790
to have access to this innovation.

450
00:15:47.431 --> 00:15:48.652
So as citizens,

451
00:15:48.712 --> 00:15:50.654
we're all very much aligned on the subject.

452
00:15:50.974 --> 00:15:51.895
But today,

453
00:15:52.215 --> 00:15:52.996
these innovations,

454
00:15:53.016 --> 00:15:54.097
they cost more and more.

455
00:15:54.357 --> 00:15:55.818
They're expensive to develop,

456
00:15:56.178 --> 00:15:56.438
I mean,

457
00:15:56.459 --> 00:15:56.939
in R&D,

458
00:15:57.139 --> 00:15:57.279
etc.

459
00:15:58.000 --> 00:15:58.440
And today,

460
00:15:58.520 --> 00:16:00.041
we don't know how to finance them,

461
00:16:00.102 --> 00:16:02.784
because we don't look at what the benefit will be either,

462
00:16:03.064 --> 00:16:03.965
that they'll bring

463
00:16:04.325 --> 00:16:06.766
because it might be fewer days of hospitalization,

464
00:16:06.806 --> 00:16:08.047
it might be many things.

465
00:16:08.487 --> 00:16:10.388
And all of that isn't valued,

466
00:16:10.428 --> 00:16:11.649
quantified and so on.

467
00:16:12.049 --> 00:16:12.229
But,

468
00:16:12.389 --> 00:16:12.609
well,

469
00:16:12.870 --> 00:16:13.710
it's not just France.

470
00:16:13.711 --> 00:16:13.950
You know,

471
00:16:14.230 --> 00:16:16.091
all countries are in the same situation.

472
00:16:16.472 --> 00:16:17.292
But in any case,

473
00:16:18.172 --> 00:16:20.214
there are real issues on which

474
00:16:20.734 --> 00:16:21.434
I was going to say,

475
00:16:21.534 --> 00:16:21.694
well,

476
00:16:21.714 --> 00:16:22.955
we also need to reflect.

477
00:16:23.335 --> 00:16:26.017
Then there are questions that are borderline societal.

478
00:16:26.477 --> 00:16:28.318
It's how far I push innovation.

479
00:16:28.598 --> 00:16:29.699
Because at some point,

480
00:16:29.959 --> 00:16:33.821
we might have to tell ourselves that we all have to die one day after all.

481
00:16:34.081 --> 00:16:36.642
So the goal isn't to reach 130 years.

482
00:16:37.262 --> 00:16:38.662
It's not necessarily that either.

483
00:16:39.022 --> 00:16:39.763
Can I ask you your...

484
00:16:40.103 --> 00:16:41.603
So what would be the ideal scenario?

485
00:16:41.783 --> 00:16:42.203
Basically,

486
00:16:42.303 --> 00:16:43.264
what would that look like,

487
00:16:43.404 --> 00:16:46.965
even if it's a bit complex to do it in two or three sentences?

488
00:16:47.265 --> 00:16:47.845
I think that,

489
00:16:48.285 --> 00:16:48.765
first of all,

490
00:16:48.785 --> 00:16:51.566
the two systems really should be clearly separated.

491
00:16:52.386 --> 00:16:58.948
We decide what we want to be with an economy which will be complex because you have companies that are also binary.

492
00:16:59.328 --> 00:17:00.828
Take people like Pierre Fabre.

493
00:17:01.029 --> 00:17:02.609
They have both mature products.

494
00:17:02.889 --> 00:17:04.170
and innovative products.

495
00:17:04.650 --> 00:17:07.452
So it is going to be very complicated.

496
00:17:07.772 --> 00:17:08.612
Then for France,

497
00:17:08.672 --> 00:17:09.793
it's the global market?

498
00:17:10.293 --> 00:17:10.693
That's right.

499
00:17:10.953 --> 00:17:12.935
So in my opinion,

500
00:17:12.975 --> 00:17:17.737
we're going to have to try to separate the two models because the two models can't follow the same rules,

501
00:17:17.897 --> 00:17:20.399
even though in terms of regulatory quality,

502
00:17:20.859 --> 00:17:23.841
we agree that everyone should be the same.

503
00:17:24.041 --> 00:17:25.221
But from a tax perspective,

504
00:17:25.241 --> 00:17:27.863
it's different because we're not dealing with the same models.

505
00:17:28.243 --> 00:17:28.523
Actually,

506
00:17:28.563 --> 00:17:30.564
the difference will only become more obvious.

507
00:17:31.185 --> 00:17:31.365
Well,

508
00:17:31.465 --> 00:17:31.705
yes.

509
00:17:33.305 --> 00:17:34.025
inevitably.

510
00:17:34.285 --> 00:17:37.966
And then afterwards,

511
00:17:38.026 --> 00:17:39.767
there are plenty of political debates.

512
00:17:40.387 --> 00:17:42.148
So there are savings to be made.

513
00:17:42.748 --> 00:17:44.048
We're all convinced of that,

514
00:17:45.528 --> 00:17:46.309
consuming better,

515
00:17:46.389 --> 00:17:47.249
prescribing better,

516
00:17:47.389 --> 00:17:48.349
all of that is certain.

517
00:17:50.810 --> 00:17:51.270
Personally,

518
00:17:51.330 --> 00:17:52.530
I think that in particular,

519
00:17:52.570 --> 00:17:55.251
there's work to be done with the pharmaceutical academies,

520
00:17:55.271 --> 00:17:56.291
the medical academies,

521
00:17:56.351 --> 00:18:01.413
precisely to manage this aspect of consuming better and prescribing better.

522
00:18:02.221 --> 00:18:03.642
less waste in hospitals as well,

523
00:18:04.303 --> 00:18:05.804
because with fewer and fewer staff,

524
00:18:06.024 --> 00:18:07.886
there are inevitably inefficiencies,

525
00:18:07.966 --> 00:18:08.286
let's say,

526
00:18:08.306 --> 00:18:08.887
in the system,

527
00:18:09.227 --> 00:18:10.468
necessarily a cost,

528
00:18:10.608 --> 00:18:12.770
but it's perhaps an investment by society.

529
00:18:13.270 --> 00:18:13.651
But then

530
00:18:14.051 --> 00:18:18.895
I'd say these are reflections where we should get everyone thinking about the subject,

531
00:18:19.275 --> 00:18:20.636
philosophers and so on,

532
00:18:21.037 --> 00:18:23.379
to understand what we want to devote to health.

533
00:18:23.899 --> 00:18:24.179
Today,

534
00:18:24.259 --> 00:18:25.881
we do have an armament budget.

535
00:18:26.321 --> 00:18:26.902
It doesn't,

536
00:18:27.302 --> 00:18:27.622
we say,

537
00:18:27.983 --> 00:18:30.705
we're going to put several billion into our moment.

538
00:18:31.357 --> 00:18:32.398
which I can understand.

539
00:18:32.678 --> 00:18:35.461
We're all aware that we're just surrounded by crazy people.

540
00:18:35.941 --> 00:18:39.525
So we're okay with saying we invest to protect ourselves.

541
00:18:40.085 --> 00:18:42.527
We can perhaps also invest in health care.

542
00:18:43.028 --> 00:18:45.110
But it's really a societal discussion.

543
00:18:45.470 --> 00:18:45.690
Yes,

544
00:18:45.791 --> 00:18:47.292
these are major projects of,

545
00:18:48.133 --> 00:18:48.853
it's about saying,

546
00:18:48.913 --> 00:18:49.094
yes,

547
00:18:49.134 --> 00:18:53.197
it's an investment and there won't necessarily be a return on investment that will be,

548
00:18:53.698 --> 00:18:56.901
the return on investment will be a better quality of life and years of life.

549
00:18:57.797 --> 00:19:01.659
And we don't penalize small molecules and industrial sectors.

550
00:19:02.219 --> 00:19:02.679
Exactly.

551
00:19:02.739 --> 00:19:05.220
And so my second topic was transparency.

552
00:19:05.280 --> 00:19:06.461
It's very important to me.

553
00:19:08.162 --> 00:19:09.582
Transparency towards the patient.

554
00:19:10.042 --> 00:19:10.182
Yeah,

555
00:19:10.262 --> 00:19:11.683
transparency towards the patient,

556
00:19:11.743 --> 00:19:16.105
because I find that we desperately lack transparency regarding the place of manufacture.

557
00:19:16.445 --> 00:19:16.725
Today,

558
00:19:16.805 --> 00:19:18.426
when you buy something on Amazon,

559
00:19:18.486 --> 00:19:19.987
they tell you where it was made.

560
00:19:20.447 --> 00:19:22.067
In the pharmaceutical industry,

561
00:19:22.408 --> 00:19:24.529
we tell you where the medicine is released.

562
00:19:24.929 --> 00:19:25.049
you

563
00:19:25.509 --> 00:19:27.950
you might have a nice address in Rueil-Malmaison,

564
00:19:28.110 --> 00:19:30.230
even though the product was actually made in China.

565
00:19:30.711 --> 00:19:31.571
So for us,

566
00:19:31.751 --> 00:19:34.452
this French production should not only be valued,

567
00:19:34.512 --> 00:19:35.772
but not just because it's

568
00:19:36.192 --> 00:19:37.132
French production,

569
00:19:37.232 --> 00:19:42.294
it's also because patients have the right to know and must know where it was made.

570
00:19:42.794 --> 00:19:48.456
And I'm convinced we'd all be okay with paying a bit more if we knew it was made in France or in Europe,

571
00:19:48.776 --> 00:19:52.777
because clearly this local manufacturing is already a CSR initiative.

572
00:19:53.201 --> 00:19:53.621
Basically,

573
00:19:53.702 --> 00:19:57.525
we can't claim to be CSR compliant everywhere except for medicine.

574
00:19:57.905 --> 00:19:58.906
So that's the first thing.

575
00:19:59.187 --> 00:19:59.587
Secondly,

576
00:19:59.607 --> 00:20:00.608
it creates jobs.

577
00:20:01.048 --> 00:20:01.629
And thirdly,

578
00:20:01.749 --> 00:20:04.451
it explains why it might be a little more expensive.

579
00:20:04.772 --> 00:20:07.214
Because environmental standards aren't the same.

580
00:20:07.514 --> 00:20:09.196
Because labor is more expensive.

581
00:20:09.476 --> 00:20:10.517
Because it costs.

582
00:20:11.035 --> 00:20:12.195
more to manufacture.

583
00:20:12.555 --> 00:20:13.696
So we're okay with,

584
00:20:13.876 --> 00:20:14.116
say,

585
00:20:14.296 --> 00:20:16.197
when we buy a jar of local jam,

586
00:20:16.437 --> 00:20:19.978
we think it's normal for it to cost more than Bonne Maman,

587
00:20:20.058 --> 00:20:21.098
which is industrial.

588
00:20:21.338 --> 00:20:22.618
It's the same for medicine.

589
00:20:23.039 --> 00:20:27.560
So that can justify a 50 cent or one euro premium to say,

590
00:20:28.040 --> 00:20:29.881
at least I'm consuming locally.

591
00:20:30.321 --> 00:20:31.821
It has an information sharing approach.

592
00:20:32.141 --> 00:20:32.561
Exactly.

593
00:20:34.002 --> 00:20:37.023
And did you choose from the start to manufacture in Europe,

594
00:20:37.043 --> 00:20:37.603
in France?

595
00:20:37.823 --> 00:20:38.103
Yes.

596
00:20:38.799 --> 00:20:40.280
Today at Helixol Laboratory,

597
00:20:40.440 --> 00:20:41.200
90%

598
00:20:41.201 --> 00:20:43.861
of our production is in Europe and 55%

599
00:20:44.221 --> 00:20:44.782
in France,

600
00:20:44.822 --> 00:20:45.862
including 55%

601
00:20:46.142 --> 00:20:46.702
in France,

602
00:20:47.123 --> 00:20:48.183
including the API.

603
00:20:48.243 --> 00:20:49.283
So it's a real choice.

604
00:20:49.884 --> 00:20:54.065
Was it a rationale from the beginning to say at first it was a bit by chance,

605
00:20:54.346 --> 00:20:56.206
then I got involved with the association.

606
00:20:56.246 --> 00:20:58.447
So it's like obelisks falling into the cauldron.

607
00:20:59.168 --> 00:20:59.928
You couldn't turn back?

608
00:21:00.288 --> 00:21:06.991
Now I'm hooked on it because I think it's so important to be consistent in your approach that I consequently feel whole.

609
00:21:07.383 --> 00:21:09.584
I look at myself in the mirror every morning.

610
00:21:09.925 --> 00:21:10.745
I apply this.

611
00:21:10.825 --> 00:21:11.846
I stand by it.

612
00:21:11.926 --> 00:21:17.769
I advocate for it and so on because I have this approach that's totally consistent.

613
00:21:17.809 --> 00:21:18.630
And I'm proud,

614
00:21:18.810 --> 00:21:22.852
just as I'm proud to have created jobs at Hiluxo and so on.

615
00:21:23.513 --> 00:21:25.654
I'm also proud to uphold these values,

616
00:21:25.934 --> 00:21:28.015
not just for the sake of patriotism.

617
00:21:28.476 --> 00:21:32.438
It's just that we feel like we're creating something that has meaning.

618
00:21:32.878 --> 00:21:33.239
Exactly.

619
00:21:33.319 --> 00:21:33.819
That's just it.

620
00:21:34.299 --> 00:21:39.482
I have a thought that comes to mind because I also see many pharmaceutical entrepreneurs who have this approach of

621
00:21:39.942 --> 00:21:41.323
I'm doing it because it makes sense.

622
00:21:41.363 --> 00:21:41.823
And anyway,

623
00:21:42.063 --> 00:21:42.984
no matter what happens,

624
00:21:43.284 --> 00:21:43.644
I'll do it.

625
00:21:43.964 --> 00:21:45.085
And sometimes it's saying,

626
00:21:45.785 --> 00:21:46.145
for now,

627
00:21:46.165 --> 00:21:47.306
I'm not making money on it,

628
00:21:47.386 --> 00:21:48.707
but I know that eventually

629
00:21:49.047 --> 00:21:53.449
I will do everything I can to show KPIs and demonstrate things so that it becomes profitable.

630
00:21:53.770 --> 00:21:55.110
I don't know if that resonates with you,

631
00:21:55.111 --> 00:22:00.513
if you have examples like that of saying basically of seeing a big picture in saying,

632
00:22:00.693 --> 00:22:01.874
I want it to be united.

633
00:22:02.114 --> 00:22:03.635
I want it to go in this direction.

634
00:22:04.011 --> 00:22:04.311
Actually,

635
00:22:04.411 --> 00:22:05.631
I'll manage so that it...

636
00:22:06.132 --> 00:22:06.332
Yes.

637
00:22:06.492 --> 00:22:06.652
Well,

638
00:22:06.832 --> 00:22:07.092
anyway,

639
00:22:07.132 --> 00:22:07.752
it's our job.

640
00:22:08.032 --> 00:22:08.272
I mean,

641
00:22:08.332 --> 00:22:08.712
honestly,

642
00:22:08.912 --> 00:22:09.533
in an SME,

643
00:22:09.733 --> 00:22:10.493
it's still very,

644
00:22:10.553 --> 00:22:11.453
very complicated,

645
00:22:11.473 --> 00:22:11.713
you know,

646
00:22:11.813 --> 00:22:12.313
day to day.

647
00:22:13.674 --> 00:22:18.635
So I think we have to be deeply committed to believe in it and to go all the way,

648
00:22:18.955 --> 00:22:19.255
you know,

649
00:22:19.635 --> 00:22:20.356
that's for sure.

650
00:22:21.376 --> 00:22:21.776
Because,

651
00:22:22.236 --> 00:22:22.356
no,

652
00:22:22.436 --> 00:22:23.737
but there are troubles every day.

653
00:22:24.077 --> 00:22:25.897
You have a colleague resigning.

654
00:22:26.137 --> 00:22:29.098
You have an API suddenly that's no longer being made.

655
00:22:29.138 --> 00:22:32.419
you do an industrial transfer and suddenly...

656
00:22:32.803 --> 00:22:33.844
It doesn't work anymore.

657
00:22:34.144 --> 00:22:35.265
So there are always troubles.

658
00:22:35.305 --> 00:22:39.289
So we really all need to be convinced of the merits,

659
00:22:40.190 --> 00:22:42.291
of the meaning it gives to go all the way.

660
00:22:42.352 --> 00:22:43.132
That's obvious.

661
00:22:43.493 --> 00:22:44.013
The direction?

662
00:22:44.133 --> 00:22:44.313
Yes.

663
00:22:44.594 --> 00:22:44.994
Exactly.

664
00:22:45.815 --> 00:22:45.995
Now,

665
00:22:46.495 --> 00:22:48.717
what I still find a bit of a shame is that

666
00:22:49.198 --> 00:22:53.301
I frankly find that in entrepreneurship and more specifically SMEs,

667
00:22:53.662 --> 00:22:54.943
they aren't really defended,

668
00:22:55.223 --> 00:22:58.326
less defended than if you compare to systems like Germany,

669
00:22:58.866 --> 00:22:59.146
Italy,

670
00:22:59.266 --> 00:22:59.647
Spain.

671
00:23:00.131 --> 00:23:02.872
which have in 10 years gained incredible momentum.

672
00:23:03.432 --> 00:23:05.573
And they know how to support SMEs.

673
00:23:06.113 --> 00:23:06.593
In Germany,

674
00:23:06.693 --> 00:23:07.253
it's been long.

675
00:23:07.653 --> 00:23:07.933
Yes,

676
00:23:08.033 --> 00:23:10.594
but the transition from SME to mid-cap,

677
00:23:11.474 --> 00:23:12.374
especially in Italy,

678
00:23:12.774 --> 00:23:17.196
you have many family structures that continue to develop and that are helped.

679
00:23:17.436 --> 00:23:18.696
And it's okay to help them,

680
00:23:18.756 --> 00:23:19.336
whereas we,

681
00:23:19.796 --> 00:23:20.157
frankly,

682
00:23:20.237 --> 00:23:23.938
sometimes feel like treated like big pharma a bit.

683
00:23:24.118 --> 00:23:29.139
And then not understanding that actually the local a

684
00:23:29.679 --> 00:23:30.140
footprint,

685
00:23:30.240 --> 00:23:31.000
job creation,

686
00:23:31.120 --> 00:23:31.480
all that,

687
00:23:31.861 --> 00:23:32.001
well,

688
00:23:32.002 --> 00:23:33.161
it makes sense after all.

689
00:23:33.522 --> 00:23:34.422
When you go into...

690
00:23:35.363 --> 00:23:36.083
Historical too.

691
00:23:36.303 --> 00:23:36.543
Yes.

692
00:23:37.064 --> 00:23:39.145
When we see in small provincial towns that,

693
00:23:39.225 --> 00:23:39.385
well,

694
00:23:40.506 --> 00:23:42.967
it's the industry nearby that keeps things running.

695
00:23:43.348 --> 00:23:43.588
Yes,

696
00:23:43.828 --> 00:23:44.588
it makes sense.

697
00:23:44.668 --> 00:23:44.928
I mean,

698
00:23:44.989 --> 00:23:45.349
frankly.

699
00:23:45.829 --> 00:23:46.770
And when we,

700
00:23:47.210 --> 00:23:47.950
among young people,

701
00:23:48.030 --> 00:23:53.934
I find that we don't sell pharma enough because pharma still has a rather bad image among young people.

702
00:23:54.314 --> 00:23:55.655
And I think that's a real shame.

703
00:23:56.047 --> 00:23:56.807
Because as you say,

704
00:23:56.887 --> 00:23:57.508
there's meaning,

705
00:23:57.548 --> 00:23:58.968
there's meaning in everything we do.

706
00:23:59.849 --> 00:24:01.269
We work for people's health.

707
00:24:01.370 --> 00:24:03.350
We work for a territorial footprint.

708
00:24:03.531 --> 00:24:05.651
And so therefore a CSR side,

709
00:24:05.672 --> 00:24:06.212
et cetera.

710
00:24:06.652 --> 00:24:08.233
And we should inspire people with that.

711
00:24:08.513 --> 00:24:12.034
And so I find that this pharma that remains a bit obscure,

712
00:24:13.055 --> 00:24:13.575
insular,

713
00:24:13.895 --> 00:24:14.255
et cetera,

714
00:24:14.296 --> 00:24:15.036
I think that we

715
00:24:15.576 --> 00:24:16.697
SMEs, on the contrary,

716
00:24:17.077 --> 00:24:19.278
must do this work of openness,

717
00:24:19.318 --> 00:24:20.398
of transparency,

718
00:24:20.819 --> 00:24:21.619
and then accept.

719
00:24:21.959 --> 00:24:22.299
To say,

720
00:24:22.379 --> 00:24:22.519
well,

721
00:24:22.579 --> 00:24:22.800
yes,

722
00:24:22.860 --> 00:24:25.241
we've had some bad apples who didn't do their job well,

723
00:24:25.301 --> 00:24:25.441
etc.

724
00:24:26.202 --> 00:24:27.083
The big scandals,

725
00:24:27.143 --> 00:24:27.283
etc.

726
00:24:28.303 --> 00:24:28.724
It's OK,

727
00:24:29.264 --> 00:24:31.085
but it doesn't mean everyone is the same.

728
00:24:31.426 --> 00:24:33.147
And then behind it,

729
00:24:33.148 --> 00:24:35.228
it doesn't mean that we can't also improve.

730
00:24:35.869 --> 00:24:36.289
Exactly.

731
00:24:38.490 --> 00:24:39.051
But really,

732
00:24:39.351 --> 00:24:41.933
I think that regarding the new generations,

733
00:24:42.013 --> 00:24:45.295
we have to bring young people into the factories.

734
00:24:45.355 --> 00:24:46.016
Because today,

735
00:24:46.436 --> 00:24:48.898
we desperately lack people to run the factories.

736
00:24:49.018 --> 00:24:50.859
It's not enough to say we're re-industrializing.

737
00:24:51.335 --> 00:24:54.779
People have to work there and those people need to be proud of what they do.

738
00:24:55.320 --> 00:24:56.061
And when we,

739
00:24:56.622 --> 00:24:56.922
you see,

740
00:24:57.042 --> 00:24:57.803
during COVID,

741
00:24:57.863 --> 00:24:59.365
we had specifically,

742
00:24:59.525 --> 00:25:01.708
we have our biggest product manufactured.

743
00:25:01.748 --> 00:25:02.649
It's made in Italy.

744
00:25:03.050 --> 00:25:06.314
It was the region of Italy that was hardest hit by COVID.

745
00:25:06.714 --> 00:25:08.617
We had zero production delays,

746
00:25:09.057 --> 00:25:10.059
meaning those guys.

747
00:25:10.595 --> 00:25:14.117
Despite the fact that people were dying everywhere in every neighborhood and so on,

748
00:25:14.458 --> 00:25:15.899
they kept going in to produce.

749
00:25:16.299 --> 00:25:16.419
Well,

750
00:25:16.499 --> 00:25:16.959
I find,

751
00:25:17.019 --> 00:25:17.279
I mean,

752
00:25:17.340 --> 00:25:17.900
telling you this,

753
00:25:17.940 --> 00:25:18.921
I still get chills.

754
00:25:19.281 --> 00:25:22.403
I tell myself there are people who risked their lives to go and produce.

755
00:25:22.763 --> 00:25:22.923
Well,

756
00:25:22.963 --> 00:25:23.564
it's beautiful,

757
00:25:23.624 --> 00:25:23.864
really.

758
00:25:24.204 --> 00:25:25.825
So we should carry that meaning forward.

759
00:25:26.165 --> 00:25:29.948
And that's what I slightly criticized today about this big pharma side,

760
00:25:29.968 --> 00:25:31.349
a bit insular and so on.

761
00:25:31.749 --> 00:25:32.149
It's saying,

762
00:25:32.209 --> 00:25:32.390
wait,

763
00:25:32.470 --> 00:25:32.770
guys,

764
00:25:32.830 --> 00:25:36.152
there are still people doing their jobs in service to others.

765
00:25:36.733 --> 00:25:37.573
And that makes sense.

766
00:25:38.073 --> 00:25:39.234
So with the new generation,

767
00:25:39.294 --> 00:25:40.275
that should resonate.

768
00:25:40.827 --> 00:25:41.507
And once again,

769
00:25:41.627 --> 00:25:43.288
these people are not in opposition.

770
00:25:43.628 --> 00:25:44.768
We all need everyone.

771
00:25:45.048 --> 00:25:51.290
But it's important that we make it known that the everyday product that French people take for their blood pressure,

772
00:25:51.310 --> 00:25:52.410
for their diabetes,

773
00:25:52.710 --> 00:25:54.251
it can come from a French SME.

774
00:25:54.771 --> 00:25:55.111
Thank you,

775
00:25:55.112 --> 00:25:55.651
Karine.

776
00:25:55.751 --> 00:25:58.852
It was fascinating to dive into so many details,

777
00:25:59.032 --> 00:26:10.315
into an entrepreneurial adventure to show that pharma is also about things that are very different from what we might be used to seeing or reading in mainstream media.

778
00:26:10.535 --> 00:26:12.616
Thank you for giving me this opportunity to speak.

779
00:26:13.176 --> 00:26:15.098
If you've been inspired by Corrine's journey,

780
00:26:15.578 --> 00:26:21.881
don't hesitate to share this episode with the entrepreneurs in your network and share what you thought of it with Corrine on LinkedIn.

781
00:26:22.362 --> 00:26:23.582
She'll be delighted to hear from you.

782
00:26:23.982 --> 00:26:24.503
See you soon.

783
00:26:25.463 --> 00:26:26.104
In this series,

784
00:26:26.105 --> 00:26:27.244
a common thread emerges.

785
00:26:27.705 --> 00:26:29.385
Innovation is in global competition.

786
00:26:29.666 --> 00:26:33.128
Access is negotiated locally and production struggles economically.

787
00:26:33.808 --> 00:26:34.748
Science creates hope,

788
00:26:34.788 --> 00:26:37.270
but ultimately it's reality that determines the impact.

789
00:26:37.870 --> 00:26:39.291
And this reality is political.

790
00:26:40.155 --> 00:26:40.796
In the comments,

791
00:26:40.876 --> 00:26:45.101
tell me if you think Europe should actively support its local pharmaceutical production.

792
00:26:45.922 --> 00:26:46.783
Throughout this series,

793
00:26:46.883 --> 00:26:48.405
my perspective has become clearer.

794
00:26:49.106 --> 00:26:50.167
We've seen different angles,

795
00:26:50.187 --> 00:26:51.529
but the same common thread.

796
00:26:52.650 --> 00:26:54.573
Innovation does not exist in a power vacuum.

797
00:26:54.853 --> 00:26:56.355
It is shaped by power dynamics.