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Healthcare insurance & reimbursement
landscape in ASEAN markets
Tokyo, 18th March 2015
Deallus Contact:
Carole Brückler, PhD
Partner, Head of Japan and Asia-Pacific
[email protected]
+65 6823 6836
Deallus Contact:
Ichiro Masuda
Principal, Head of Japan Operations
[email protected]
+81 70 1542 9876
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Why does Asia / ASEAN matter?
ASEAN Regional trends
Concept Overview
Country Discussion
Conclusions and Business Opportunities
Deallus Introduction
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2
Why does Asia / ASEAN matter?
ASEAN Regional trends
Concept Overview
Country Discussion
Conclusions and Business Opportunities
Deallus Introduction
Client Confidential – Do not share
3
Why does Asia / ASEAN matter?
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4
Why Asian Markets Are Attractive
❶ Rising Healthcare Expenditure Expands the Healthcare Market
Healthcare spending grew substantially across Asia
(Top-left illustration).
Source: Growing Healthcare
Spending In Southeast Asia
Brings Opportunity, 2014,
BDG Asia
❼
50.0%
41.6%
40.0%
❽
❹
37.3%
37.6%
❶
❸❷
❺
❻
32.7%
28.9%
30.0%
1. East Asia and Pacific
2. South East Asia
3. South Asia
4. LaTam
5. MENA
6. Sub-Saharan Africa
7. North America
8. EU
22.4%
20.0%
11.9%
10.0%
0.0%
❶
-10.0%
❷
❸
❹
❺
❻
Whilst a steady growth of pharmaceutical market is
expected in the developed market (1-4% CAGR2012-2017),
the significant rise of healthcare spending in the key
Asian countries will lead the huge drive of pharma
market growth in the next 5-10 years (Bottom-left
illustration).
The sharpest ever rise in the healthcare spending for
the past 4 years (2009-2012) was observed in a few
Asian countries including Indonesia (67.8% CAGR),
Philippines (52.1%), Myanmar (50.5%), Malaysia
(43.6%) and Vietnam (42.7%).
The trend in the region is anticipated to continue
throughout to 2018 thanks to the region’s rapidly
growing economics, expansion of the affordable
social class.
❽
❼
-2.1%
2012 Health Expenditure per Capita (US$)
(Public + Private)
%Growth of Per Capita Healthcare Spending (2009-2012)
10,000
Australia
12.8%
Sri Lanka
100
Laos
China
Thailand
Mongolia
Cambodia
Philippines
Indonesia
Vietnam Asia Market
India
Pakistan Size CAGR
Bangladesh(2012-2018)
7%
Nepal
10
0.01
South Korea
Asia Spending
CAGR (20122018)
Malaysia
1,000
Japan
Taiwan
Developed markets Source: The World Bank Data
Myanmar
0.1
1
Asia as a region is the fastest growing part of the
global economy. In 2001, the region accounted for
26.8% of global GDP (measured using purchasing
power parity). By 2013, that share had risen to
36.6%.
The rapid income growth means that healthcare
spending in the region is also growing faster than
anywhere else.
Emerging markets
10
100
1000
Nascent markets
Espicom The Pharmaceutical Market Reports
Frost & Sulivan, Top Five Growth Sectors in the
Asia-Pacific Healthcare Market, Global Pharma
Market Outlook – with focus on emerging
markets, IMS Health
Pharmaceutical Market Size in 2012 (US$ Billion)
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5
Why Asian Markets Are Attractive
❷ Rapid Demographic Change Drives Healthcare Industry Growth
Aging Asia presents huge opportunities for industries that provide products and services to the
elderly
Asia stands out as being the most exciting part of the world for healthcare businesses. As growing
richer, having broader exposure to improvements in medicine, Asian countries are expected to
experience tremendous ‘ageing’ (Bottom-left illustration)
Change of wealth distribution will drive the expansion of pharmaceutical market size in the next 10
years.
A significant proportion of the new Asian middle class are also expected to be at the upper end of
the income bracket, with impressive spending power (Bottom-right illustration)
Asia rapidly turns to Aging Society
Rapid growth of middle class in Asia
One of the most attractive opportunities in Asia centres on the region’s changing
age profile, of which the elderly population aged 65 and over will reach 11.6%
by 2030
600
■ Population of
over 65 (mln)
■ %Population
of over 65
Two-thirds of the global middle class is expected to live in the Asia-pacific
region, up from just under one-third in 2009
12%
500
10%
400
8%
300
6%
200
4%
100
2%
Estimated total income
by band 2010 and 2020
in China (Annual
income, thousands of
people)
0%
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
Number of people aged 65 and over in Asia Pacific in
millions and % of the total population
Source: Asia Rising,
Healthcare, 2014, The
Economist
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Source: Middle Class Growth
in Emerging Markets, Earnst
& Young
6
Why Asian Markets Are Attractive
❸ Booming Foreign Investment Creates More Opportunities
Illustrative
Increasing affluence and demand for better are forcing
previously protectionist Asian governments to be more
open to give leeway to foreign companies (Top-Left
illustration)
Increasing business transparency and policy
continuity has lifted the chronic risks existing in some
region, boosting market rewards in the recent years
Vietnam
Market Attractiveness
Rating
Addressable Market
Ease of Import
Indonesia
•
Overall
Market Attractiveness
Stance of Foreign Investment
Addressable Market
Foreign healthcare investors
enjoy a corporate income tax rate
of 10%, tax exemption over the
first four years of a project and a
50% subsequent tax break in the
following years.
Ease of Import
Distribution Reach
Overall
Stance on Foreign Investment
Source: Healthintel Asia, 2013
EOS Intelligence insights, PharmaExec.com 2013
State of the Healthcare in South East Asia, Edelman Whitepaper
•
Market Attractiveness Rating
Very high
High
Medium
Rating
Low
The Negative Investment List
currently stipulates that foreign
investors may own up to 67%
(65% previously) in healthcare
related business
Heavy investment in R&D in the region has enabled
earlier ever access of pharmaceutical products in Asia
As perception changing on the importance of R&D
investment in the region, the value of medical
research in Asia is growing swiftly, with the Asia’s
share of global R&D expenditure rose from 18.1% to
23.8% (Bottom-Right illustration)
100%
80%
Share
Distribution Reach
51.2%
45.4%
60%
40%
US
28.5%
20%
0%
29.2%
18.1%
2.2%
23.8%
2007
2012
1.6%
Share of Global Expenditures on Biomedical Research in
2007 and 2012
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Europe
Asia & Oceania
RoW
Source: Asia Rising,
Healthcare, 2014, The
Economist
7
Why does Asia / ASEAN matter?
ASEAN Regional trends
Concept Overview
Country Discussion
Conclusions and Business Opportunities
Deallus Introduction
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8
ASEAN Regional Trends
Social
• Demographic changes – wealth and age distributions
• Epidemiological transitions (M&M is no longer driven by infectious diseases
but rather NCD (diabetes, COPD, cancer etc.)
• Patient preference of branded products and private health sector, where
affordable
• High income patients cross country borders to seek high standard health
care and technologies.
Technological
Economic
Political
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9
ASEAN Regional Trends
Social
Technological
• Limited pharma technology, therefore the region relies on import for
innovative drugs
• Limited requirements for technology transfer into the region
• Skilled physicians in Thailand, Malaysia, Singapore which leads to medical
tourism.
• ASEAN HTA agencies have limited technical capacity but actively
developing.
Economic
Political
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10
ASEAN Regional Trends
Social
Technological
Economic
• Growth of middle population segment with disposable income
• Increasing cost pressures on health care budgets as cost of delivery and
drugs risk outstripping budgets
• ASEAN Economic Community
Political
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11
ASEAN Regional Trends
Social
Technological
Economic
Political
• Strong political commitment for Universal Health Coverage
• Struggles with the realities of implementation UHC systems
• Willingness to make more evidence-based decision making
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12
Why does Asia / ASEAN matter?
ASEAN Regional trends
Concept Overview
Country Discussion
Conclusions and Business Opportunities
Deallus Introduction
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13
Three components of insurance coverage should be considered
What does health insurance constitute of?
“100% population coverage” does not always mean that
a certain drug is covered for 100% of population with
fixed reimbursement rate.
Height: How much is service
(pharmacy) benefit covered?
OOPs (co-payments)
Non-insured people
Non-reimbursed
drugs
Breadth: population
coverage (what % of
population is
covered?)
Depth: which health services
(drugs) are covered?
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How does this compare with Japan?
Contrasting ASEAN with the Japanese healthcare model
Component
Japan
ASEAN
Breadth:
Population
coverage
It is compulsory that
Japanese citizens
subscribe a certain type
of social health
insurance.
Population coverage
ranges from 60% to
100%
Depth:
Service (drug)
coverage
Almost all drugs
approved are listed NHI
reimbursed drug price
list
Level and standard of
drug coverage differs
from market to market.
Originators drugs are
often not reimbursed
Height:
Financial
protection
(co-payment)
Typically 20-30% of copayment
Listed drugs are highly
subsidized although
may be subject to
government or hospital
budget
It is essential to think out of “Japan box”.
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It is important to understand “what HTA exactly means”
HTA is broad term and its impact changes according to its context
Definition of Health Technology Assessment:
Health technology assessment (HTA) refers to the systematic evaluation of properties, effects,
and/or impacts of health technology. It is a multidisciplinary process to evaluate the social,
economic, organizational and ethical issues of a health intervention or health technology. The main
purpose of conducting an assessment is to inform a policy decision making. (WHO)
HTA concept
(not exhaustive)
Efficacy
Ethics
Budget
impact
Cost
effectiveness
HTA from drug reimbursement perspective
Drug
Device
When discussing HTA, it is important to understand
from what perspective HTA is mentioned
Example:
Procedure
Health
Program
Health Policy Decision Making
In 1993, HTA program, Technology
Assessment and Social Security in Thailand
(TASSIT) was introduced.
Broader HTA: Not
impactful on drug
reimbursement per se
The 2007 revision of NLED required input
from the Health Intervention and Technology
Assessment Program (HITAP) in Thailand.
High impact on drug
reimbursement
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16
Why does Asia / ASEAN matter?
ASEAN Regional trends
Concept Overview
Country Discussion
Conclusions and Business Opportunities
Deallus Introduction
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17
ASEAN Region
A 650 million people economy potential
Member countries
Indonesia
Philippines
Thailand
Vietnam
Myanmar
Malaysia
Singapore
Brunei
Darussalam
Lao PDR
Cambodia
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18
Indonesia
Indonesia
Japan
248.0
127.4
52
92
GDP in 2013 (bn USD)
870.3
4,898.5
GDP in 2019 (bn USD)
1,230.9
5,433.4
GDP per capita in 2013 (th USD)
3,510
38,468
GDP per capita in 2019 (th USD)
4,560
43,504
THE/GDP in 2012 (%)
3.0
10.1
Pharmaceutical market CAGR
(2014-2020, %)
10.2
2.0
Population in 2013 (mn people)
Urban population rate in 2013 (%)
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*GDP: Growth Domestic Product, THE: Total Health Expenditure
19
Undergoing a formidable change in health insurance
2014-2019: transition to the universal health coverage
Key indicators
Indonesia
Japan
60%
100%
Government expenditure of total
healthcare expenditure in 2012
(GGHE/THE)
39.6%
82.1%
OOP rate of total health
expenditure in 2012
45.3%
14%
OOP rate as % of private
expenditure on health in 2011
76.3%
-
Population coverage by public
financial protection schemes
Public Health Insurance Situation
UHC by 2019
image
1968
2010
46%
2014
2019
The Indonesia public health
insurance system was established
in 1968. And as of 2010,
approximately
46%
of
the
population was covered under the
five different schemes. In January
2014, the government committed to
provide healthcare insurance to all
citizens by 2019, merging all
existing schemes.
100%
Drug Coverage
HTA Situation
On-patented drugs have potential in public market
Indonesian public health system employs Diagnosis Related
Group (DRG) system which is similar to DPC system in Japan.
The government use e-catalogue system to manage medicines
in the public sector. Listing of e-catalogue and purchase price
are determined centrally and physical procurement is managed
by individual hospitals. In this system originator’s company can
join and on-patented drugs comprise about 10% in volume and
30% in expenditure. It appears that originators play in out-ofpocket private sector in general, some of certainly participate in
public sector to enjoy public funding.
HTAs have been implemented since 2014
Since 2014, HTAs has been formally implemented and evaluate
new technology similar manner to UK-NICE. Although HTA body
evaluate cost-effectiveness from various data sources, it requires
pharma companies to submit relevant data.
At this moment, procedures and interaction with pharma
companies are discussion basis. Formal guideline is not yet
available as capacity of Indonesian HTA body is limited.
However, it is estimated some form of guideline may be issued
around 2016. As Indonesia integrated several schemes into
single payer body, impact of HTA in public health sector is high
particularly for pharmaceutical industry.
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What will the spending priorities be by 2019?
One national health insurance, single payer model will impact coverage decision.
year
.
.
.
population coverage
2010
2014
2019
46%
60%
100%
Public health insurance before 2014
Askes
Active civil servants and dependants,
civil service and military retirees
Taspen
Military workers, police and their
uncovered dependents
Jamsostek
Private formal sector employees
(and dependents) of firms with 10 or
more employees
Jamkesmas
Poor and near-poor population,
based on individual and household
targeting
Jamkesda
Poor and near-poor, homeless,
orphans, and non-civil service
teachers
National Health Insurance Program
(JKN: Jamian Kesehatan Nasional)
Managed by
BPJS: the Badan Penyelenggara
Jaminan Sosial
•
•
•
Single payer model
Diagnosis-Related Group
system
HTA involvement for
technology selection
In 2014, Indonesia reformed healthcare insurance system. 5 different schemes were integrated into
one National Health Insurance Program, also known as BPJS, the Badan Penyelenggara Jaminan
Sosial Keseehatan. This will change the complicated public health care in Indonesia and expand
population and benefit coverage. According to health policy experts in Indonesia, this ambitious goal is
“achievable”. However many operational challenges are expected.
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21
Thailand
Thailand
Japan
68.2
127.4
48
92
GDP in 2013 (bn USD)
387.3
4,898.5
GDP in 2019 (bn USD)
493.3
5,433.4
GDP per capita in 2013 (th USD)
5,676
38,468
GDP per capita in 2019 (th USD)
7,047
43,504
THE/GDP in 2012 (%)
3.9
10.1
Pharmaceutical market CAGR
(2014-2020, %)
7.0
2.0
Population in 2013 (mn people)
Urban population rate in 2013 (%)
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*GDP: Growth Domestic Product, THE: Total Health Expenditure
22
Thailand is a stand-out performer in delivering care at low
OOP rates
UHC was first achieved in 2001
Population coverage by public
financial protection schemes
Thailand
Japan
98%
100%
Public Health Insurance Situation
UHC already achieved in 2001
82.1%
CSMBS: 1980Government employee
10% of population
13.1%
13.1%
SHI: 1990Private sector employee
13% of population
55.8%
-
Government expenditure of total
healthcare expenditure in 2012
(GGHE/THE)
76.4%
OOP rate of total health
expenditure in 2012
OOP rate as % of private
expenditure on health in 2011
Drug Coverage
Standard Drug List for public sector reimbursement
Drug benefit for all public insurance schemes is referenced to the
medicines quoted in the National List of Essential Medicines
(NLEM). A prescription of the nonessential drug if deemed
necessary. Depending on type of insurance, reimburse model
differs. While members of CSMBS enjoy fee-for-service payment,
SHI and UC enrolees receive treatment under capitation and DRG
system. The NLED is periodically updated by a subcommittee of
the National Drug Committee. Non-NLEM drugs need to be paid
out-of-pocket regardless of type of insurance enrolled.
UC: 2001Remaining population
74% of population
Although Thailand has dual system
of public and private health sector,
public sector plays a dominant role.
Since achievement of universal
health coverage, Thailand has
maintained its system though
various approaches such as strong
primary care gatekeeping and tough
negotiations with pharmaceutical
companies. OOP rate of 13.1%
stand out of ASEAN peers.
HTA Situation
HITAP: leading HTA body in ASEAN region
The Thai Health Intervention and Technology Assessment Program
(HITAP) is a well established HTA agency, founded in 2006. While
HITAP has no legal authority to make healthcare resource
allocation decisions itself, in its role as an advisor to the Ministry of
Public Health and other national Thai authorities, HITAP has
developed a track record in informing national policy. For example,
the 2007 revision of NLEM required cost-effectiveness evidence
produced by HITAP, which significantly impact reimbursement
decision making. HITAP is a leading HTA body in ASEAN region. It
pioneered to establish the first Asian HTA network, HTAsiaLink in
2011.
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23
Thailand has well established UHC system
The government employ capitation system to control health expenditure.
CSMBS recently employed DRGs for inpatient payment.
CSMBS
SSS
UCS
Official name
Civil Servants Medical Benefits
Scheme
Social Security Scheme
Universal Coverage Scheme
Established since
1980
1990
2002
Administrator
Controller General Department,
Ministry of Finance
Social Security Office (SSO),
Ministry of Labour
National Health Security Office
(NHSO)
Population
coverage
All civil servants, permanent
public employees, retirees, and
their dependents (7.9%)
All private employees and
temporary public employees
(15.3%)
Anyone who is not covered by
the SSS and CSMBS (75.8%)
Financing
sources
General tax revenue
Equal contributions from
employers, employees, and the
government
General tax revenue
Financing model
OP: Fee-for-Service
IP: DRGs*
Capitation
OP: capitation
IP: DRGs
Co-payment
(in principle)
No (full pay without proper
referral)
No (full pay outside contractor)
No (full pay in private sector)
Note: OP: out-patient, IP: in-patient, DRG: Diagnosis-related group
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Since the NLED 2007 revision, cost-effectiveness evidence
has been required
NLED publication
The National Drugs System
Development Committee
The Subcommittee for
Development of the NLED
The Working group for
coordination &
consolidation of NLED
Applicable to all three national
health insurance schemes
Endorsement of NLED
Setting concept, philosophy and criteria
Making final decision from the proposal
of all the Working groups.
The Health Economic Working Group commissions
Health Intervention Technology Assessment Program
(HITAP), an independent research institute under the
Ministry of Public Health, to conduct pharmacoeconomic
assessment. Results of these studies are subsequently
considered by the Subcommittee for inclusion/exclusion of
these drugs from the NLED. HITAP has also developed
guidelines on pharmacoeconomic studies.
Cost-effectiveness benchmark
Gathering information and
making recommendations
Reviewing and generating
pharmacoeconomic evidence
for selected medicines
The Health Economic
Working Group
HTA process
Commission HITAP to conduct
pharmacoeconomic assessment
16 Specific Working Group
for NLED selection
Reviewing evidences, requesting more
information and making
recommendations
NLED secretariats
Screening drug applications submitted
by pharmaceutical companies
Gathering and generating evidence
NLED development process
Any technology with a cost per quality-adjusted life-year
gained below the average GDP per capita is considered
acceptable for inclusion on the NLED.
HTA study by HITAP and Current Policy
Research projects:
Cost-utility analysis of recombinant human erythropoietin
in anemic cancer patients induced by chemotherapy
Findings:
Erythropoietin was cost-ineffective for treatment of
anemia induced by chemotherapy among cancer patients
Issues taken by:
The Subcommittee for development of the NLEM
Current policy:
Erythropoietin was not recommended for treatment of
anemia among cancer patients in Thailand
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Thailand is leading HTA movement in ASEAN region
International HTAs
HTA has evolved over this ten years and actively expanded international network
HTAsiaLink
established
Domestic HTAs
ISPOR Thai
Chapter
established
Health
Technology
Assessment
Unit
NLEM
2008 revision
collaboration
agreement
Organized
capacity
development
meeting
HITAP
established
NLEM
2004 revision
The National
HTA guidelines
and database
NLEM
2013 revision
Insurance scheme
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Universal
coverage
policy
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26
Singapore
Singapore
Japan
Population in 2013 (mn people)
5.4
127.4
Urban population rate in 2013 (%)
100
92
GDP in 2013 (bn USD)
297.9
4,898.5
GDP in 2019 (bn USD)
369.1
5,433.4
GDP per capita in 2013 (th USD)
55,182
38,468
GDP per capita in 2019 (th USD)
65,701
43,504
THE/GDP in 2012 (%)
4.7
10.1
Pharmaceutical market CAGR
(2014-2020, %)
2.0
2.0
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*GDP: Growth Domestic Product, THE: Total Health Expenditure
27
Singapore enables drug access through private saving funds
Ongoing iterations to the insurance schemes expands options
Singapore
Japan
93%
100%
Government expenditure of total
healthcare expenditure in 2012
(GGHE/THE)
37.6%
82.1%
OOP rate of total health
expenditure in 2012
58.6%
13.1%
OOP rate as % of private
expenditure on health in 2011
94.1%
-
Population coverage by public
financial protection schemes
Public Health Insurance Situation
100% coverage by Medishield Life by end of 2015
The government has taken balance of public and private spending
on health. Medisave is a compulsory national medical savings
scheme for individual hospitalization expenses. To complement
Medisave, Medishield was introduced to cover expensive medical
cost which cannot be covered by Medisave balance. Medisave and
Medishield are considered to be private spending which is the main
reason for high OOP rate. The government established what is
called three M schemes, by establishing Medifund which act as a
safety net for the poor. The government is currently working to
replace Medishield with Medishield Life which will be mandatory to
further strengthen health financing system in Singapore.
Drug Coverage
Standard Drug List for public sector reimbursement
HTA Situation
HTA to support SDL decision making
Singapore has established Standard Drug List (SDL) since 1979.
There are two groups in the SDL. SDL group 1 drugs are essential
first-line drugs for which patients pay SG$1.40 per item per week.
SDL group 2 drugs are relatively more expensive essential drugs
for which patients pay 50% of the selling price. Although there is no
subsidy for nonstandard drugs, subsidized patients can pay for
nonstandard drugs from their Medisave and/or Medishield (inpatients).
An annual call for applications for standard drugs inclusion is made
by the Ministry of Heath (MOH) to the public institutions. And Drug
Advisory Committee (DAC) in the MOH evaluates application.
HTA is employed in variety of health related decision making
process. It features in decision making for the SDL, licensing of
medical clinics, the Health Service Development Programme,
healthcare subsidies, and policy development. In the SDL selection
process, DAC work with the Pharmaco-economics and Drug
Utilization Unit of Health Science Authority (PMDA equivalent in
Singapore). The technology assessment of a drug is based on its
regulatory and formulary profile, incremental efficacy and safety,
relative cost-effectiveness, the financial impact of including the
drug in the SDL among with other epidemiological and clinical data.
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Singapore enables drug access through private saving funds
Ongoing iterations to the insurance schemes expands options
Healthcare Financing system in Singapore
3M schemes
Others
Cash
*Medishield will be updated to
Medishield Life by end of 2015 to
cover non-eligible population such as
people with pre-existing conditions
Medisave
Medishield*
Medi Fund
Compulsory
national medical
savings scheme
Low-cost
catastrophic illness
insurance scheme
Social safety net for
the poor
Private financing
Standard Drug List (SDL)
Class
Co-payment
Class I: Essential 1st line drugs
1.40 SGD per item per
week
Class II: relatively more
expensive essential drugs
50% of selling price
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Subsidy
Public financing
Medication Assistance Fund (MAF)
Assist patients with costly drugs that are not in
the SDL but have been assessed to be clinical
necessary, providing up to 75% subsidy
Drug Advisory Committee evaluates drugs with
technical assistance of the Pharmacoeconomics and Drug Utilization Unit of HSA
29
Malaysia
Malaysia
Japan
29.9
127.4
73
92
GDP in 2013 (bn USD)
313.2
4,898.5
GDP in 2019 (bn USD)
535.8
5,433.4
GDP per capita in 2013 (th USD)
10,457
38,468
GDP per capita in 2019 (th USD)
16,170
43,504
THE/GDP in 2012 (%)
3.9
10.1
Pharmaceutical market CAGR
(2014-2020, %)
9.0
2.0
Population in 2013 (mn people)
Urban population rate in 2013 (%)
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*GDP: Growth Domestic Product, THE: Total Health Expenditure
30
Full UHC access, yet the majority of growth comes from
private / OOP care
If you can afford to cut the queue…
Key indicators
Malaysia
Japan
Population coverage by public
financial protection schemes
100%
100%
Government expenditure of total
healthcare expenditure in 2012
(GGHE/THE)
55.0%
82.1%
OOP rate of total health
expenditure in 2012
35.6%
14%
79%
-
OOP rate as % of private
expenditure on health in 2011
Public Health Insurance Situation
Rise of private sector affect OOP rate
Malaysia has achieved universal health coverage through a public
healthcare system providing near-free comprehensive care
financed though general taxation. However private healthcare
system is getting popularity to meet demand of wealthier people
which, which is the reason for high OOP rate despite of the UHC
system. The government has faced challenges as to how to
balance public and private sector and maintain UHC in the country.
In 2012 the government proposed “1Care for 1Malaysia” policy
which would allow the insured to access private facilities. However,
it appear to be unsuccessful so far. The government seem to be
struggling to modify the distort of UHC in Malaysia.
Drug Coverage
HTA Situation
Low OOP in public; High OOP in private
HTA on drugs is still limited
Drugs available in the public sector are highly subsidized (8090%). Each public hospital has their own budget allocated and
each hospital manage within the budget. Although drugs are
highly subsidized, it is unclear that how their own budget is
allocated to drugs and it is up to their financial situation. In
private sector, majority of drugs are paid directly from patients
which drive up OOP rate in Malaysia.
Domestically available generics as well as absence on pricing
regulations further contribute to a market with high complexity.
Malaysia HTA Section (MaHTAS), a department of Ministry of
Health, published the drug formulary and guideline for
pharmacoeconomics in the past two years. The areas covered in
the guidelines include: the types of economic evaluation that
need to be carried out by, the costing approaches that are
acceptable, the outcome issues, discounting, sensitivity analysis,
the acceptable cost-effective ration and also the budget impact
analysis. However, due to limited capacity, the number is drugs
evaluated are limited. Recent study was to evaluate and
recommend pneumococcal vaccine for children below five yeas
old to its national immunization program.
Client Confidential – Do not share
31
Philippines
Philippines
Japan
97.5
127.4
45
92
GDP in 2013 (bn USD)
272.1
4,898.5
GDP in 2019 (bn USD)
517.3
5,433.4
GDP per capita in 2013 (th USD)
2,791
38,468
GDP per capita in 2019 (th USD)
4,712
43,504
THE/GDP in 2012 (%)
4.6
10.1
Pharmaceutical market CAGR
(2014-2020, %)
9.4
2.0
Population in 2013 (mn people)
Urban population rate in 2013 (%)
Client Confidential – Do not share
*GDP: Growth Domestic Product, THE: Total Health Expenditure
32
PhilHealth has a broad reach in the population
Expansions into the remaining population sectors have been mandated
Philippines
Japan
78%
100%
Government expenditure of total
healthcare expenditure in 2012
(GGHE/THE)
37.7%
82.1%
OOP rate of total health
expenditure in 2012
52.0%
13.1%
83.5
-
Population coverage by public
financial protection schemes
OOP rate as % of private
expenditure on health in 2011
Drug Coverage
Reimbursement is based on pre-determined ceilings
PhilHealth is responsible for the reimbursement of drugs on the
PNDF. PhilHealth manages drug cost through pre-determined
ceilings, which are decided based on the severity of the disease
and the classification of hospitals. For example, the benefit ceilings
for drugs when patients are in secondary hospital are USD75 for
case type A (simple) diseases, USD249 for case type B (moderate)
diseases, USD499 for case type C (severe) diseases. The
Philippine National Drug Formulary (PNDF) lists reimbursable
drugs under the National Health Insurance Program in addition to a
positive list, which is a compilation of non-PNDF drugs that are also
reimbursable. Please note prior instances of mandated price cuts.
Public Health Insurance Situation
Further political support to complete UHC
Philippine Health Insurance Corporation (PHIC), more commonly
knowns as PhilHealth administers the National Health Insurance
Programme. The NHIP’s target was to attain universal coverage
within 15 years of its implementation in 1995. However, as of 2012
PhilHealth covered approximately 78% of the total population.
Philippines’ decentralized healthcare service is also challenge to
support efficient comprehensive care. In 2013, the president of
the Philippines amended the National Health Insurance Act of
1995, which mandates the government to shoulder the premiums
for the insurance of the indigent and informal sectors. This is
estimated to drive coverage and benefit expansion.
HTA Situation
HTA is not yet formally implemented on drugs
The first HTA attempt was initiated when the HTA Committee in
PhilHealth was established in 1999. The committee aimed to
develop reimbursement policies. One of major functions of the
committee was conduct of drug assessments to determine which
drug should be reimbursed. However, due to lack of political
support and leadership changes, HTA underwent period of silence .
Since 2009, several policies have made breakthrough to revive
HTA. Department of Health is now active partnering with NICE and
Thailand’s Health Intervention and Technology Assessment
Program. However HTA is not yet formally implemented in drug
reimbursement decision process.
Client Confidential – Do not share
33
Vietnam
Vietnam
Japan
89.7
127.4
32
92
GDP in 2013 (bn USD)
170.6
4,898.5
GDP in 2019 (bn USD)
281.4
5,433.4
GDP per capita in 2013 (th USD)
2,497
38,468
GDP per capita in 2019 (th USD)
2,948
43,504
THE/GDP in 2012 (%)
6.6
10.1
Pharmaceutical market CAGR
(2014-2020, %)
15.4
2.0
Population in 2013 (mn people)
Urban population rate in 2013 (%)
Client Confidential – Do not share
*GDP: Growth Domestic Product, THE: Total Health Expenditure
34
Strong public commitment to expand UHC coverage
But incentives for overconsumption of services and drugs hinder this
Vietnam
Japan
65%
100%
Government expenditure of total
healthcare expenditure in 2012
(GGHE/THE)
42.6%
82.1%
OOP rate of total health
expenditure in 2012
48.8%
13.1%
OOP rate as % of private
expenditure on health in 2011
83.2%
-
Population coverage by public
financial protection schemes
Public Health Insurance Situation
Commitment to cover 80% of population by 2020
The national Social Health Insurance (SHI) program was
established when Health Insurance Law was passed in 2009. The
government consolidated existing scheme into one SHI program
which is, in principle, a single payer and a single pool with a unified
benefits package model. However, enrolment rates remain low,
and funds pooling is highly fragmented. High OOP rate indicates
the SHI system is not functioning well. In 2012, the Ministry of
Health produced the “Master Plan for Universal Health Coverage
from 2012-2015 and 2020” The Master Plans clearly set target to
reach SHI coverage of 70% by 2015 and 80% by 2020, and to
reduce OOPs to less than 40% of total expenditures by 2015.
Drug Coverage
Strong brand preference of the reimbursement list
HTA Situation
No HTA process in place for reimbursement
Current payment mechanism include fee-for-service, capitation,
and a DRG pilot. Due to market liberalization policy, hospitals
depend on their revenue from provision of their services which are
reimbursed by Vietnam Social Security which manages the SHI,
and paid by patients. Pharmaceutical sales are a good source of
hospital revenue. In fact health providers have a strong preference
for branded drugs, and drug expenditure account for 60% of total
VSS spending in 2010. VSS pays an average of 89.2% of total
pharmaceutical expenditure in hospitals. At this moment the Health
Insurance Reimbursement List (HIRL) is in favour of branded drug
manufacturers.
Vietnam does not have a national program for HTA or similar
evidence-based decision making process. Currently, there is no
regulated or transparent process for selecting drugs for
reimbursement, or rules about who should be on the committee to
represent different stakeholders. VSS, the payer of the SHI, has no
direct role in the benefit package decision making process.
Selection of reimbursed drugs is decentralized and subject to
hospital preference.
Client Confidential – Do not share
35
The government commit not only population coverage but
also OOP rate
year
.
.
.
2009
population coverage
OOP rate
Various programs
Health Insurance Law
2012
2015
2020
65%
70%
80%
48.8%
<40%
Master plan for UHC
Program A
Program B
Social Health Insurance
Managed by
Vietnam Social Security
Program C
•
Single payer model
Healthcare Fund for Poor
Client Confidential – Do not share
36
Why does Asia / ASEAN matter?
ASEAN Regional trends
Concept Overview
Country Discussion
Conclusions and Business Opportunities
Deallus Introduction
Client Confidential – Do not share
37
Evolving HTA dynamics: Keep an eye on collaboration
mechanism to understand change and influencing factors
Various stakeholders are collaborating to develop and promote
pharmacoeconomics and HTA in Asia
Multi-stakeholder network
Government / HTA agent network
Global
*Annual meeting: 2016 in Tokyo
International Society for
Pharmacoeconomics and
Outcomes Research
*
ISPORS has regional affiliation
Asia regional
HTA net Asia
Foundation: 2011
Foundation: 2003 in Japan
Members:
Members:
Governments or
HTA agencies only
Scope and Activities:
HTA is the main focus. Health economic is part of scope.
Annual conference
(4th conference: May 2015 in Taiwan) /
News Letters
HTA
HEOR
Various stakeholders including
academia, industry, patients
Scope and Activities:
Health economic and outcome research is main focus. HTA is
a part of its scope.
Biennial Asia-Pacific conference
(7th Conference: 2016 in Singapore)/
HEOR
HTA
Academic journal (Value in Health)/
News Letters/ Regional Chapters
Note: HTAi: Health Technology Assessment International , INHTA: The International Network of Agencies for Health Technology Assessment,
ISPOR: International Society for Pharmacoeconomics and Outcomes Research, HERO: Health Economic and Outcome Research This is not
Client Confidential – Do not share
38
exhaustive mapping.
2015 was the plan for ASEAN economic integration
Majority of initiatives are delayed and would not be achieved by end of
2015. At this moment, no immediate impact is expected for pharma industry.
Member countries
ASEAN Economic Community (AEC)
Initiatives
Status
Pharma related issues
Elimination of nontariff barrier
Not progressed
Integration of regulatory system
MRA of product approval
Indonesia
Philippines
Thailand
Vietnam
Myanmar
Free movement of
skilled professionals
Limited progress
Free-movement of physicians
(not started)
Malaysia
Singapore
Brunei
Darussalam
Lao PDR
Cambodia
ASEAN 2020 vision:
conceptualization of
“ASEAN community”
Current status:
Although some components of AEC
such as tariff reduction are well
progressed, majority of initiatives are
delayed. It appears that completion of
the integration by 2015 would be
unrealistic. Given this situation, ASEAN
started to discuss post-2015 vision
2016-2025.
Declaration to
establish “ASEAN
community” by 2020
Declaration to
accelerate “ASEAN
community” by 2015
Post-2015 vision
2016-2025
conceptualization
1997
2000
2003
2006
2010
2014 2015
Client Confidential – Do not share
2020
2025
39
ASEAN+3 countries are collaborating to share experiences
Regionally overarching forums are mutually influential, but no interfering
ASEAN integration does not have element of national health insurance coverage. This is because, national health
insurance is rather seen as internal political issue of each member country which is against ASEAN principle of
non-interference in the internal affairs.
However, a group of wider stakeholders, ASEAN,
China, Japan, Republic of Korea, are collaborating
toward achievement of universal health coverage in
the region. In 2012 ASEAN Plus Three UHC Network
was conceptualized. The network has work plan
2014-2016 such as monitoring UHC progresses and
capacity development. The network aim to be a
platform of information sharing and guidance toward
UHC. Although they collaborate, it is unclear if they
are producing solid outcomes to achieve their goals.
Japan is particularly active in promoting UHC as the
country has long established history. For example
Japan has been collaborating with the world bank to
share its experience. They had publication on UHC in
2014. In February this year, ministry of health started
discussion on Japan’s long term healthcare vision
which includes communicating Japan’s experience to
Asian counties.
• Cost-effective viewpoint
• Influence on Asian coutries
Although there may not be immediate impact, it is worth capturing
international dynamic and regularly assessing implication to pharma industry
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40
Why do Japanese Companies have an Advantage
in Asia?
❶ Similar Disease Pattern
Client Confidential – Do not share
41
Why Japanese Pharma have advantages
❶ Similar Disease Pattern
Similar disease patterns between Japan and Asian region results in similar unmet needs, generating synergy in
prioritizing product development strategies
Japan share more similar oncology pattern with Asian market than Western markets (Bottom-Left illustration).
Change of disease patterns in less developed Asian region will attract more Japanese pharma that specialise in
chronic disease care as well (Bottom-Right illustration).
New Cancer Cases in East Asia Countries and the US
China
Lung (18%)
Stomach (16%)
Korea
Stomach (22%)
Lung (14%)
Japan
Stomach (19%)
Colorectal (18%)
Development of Disease Pattern, 2008-2020
United
States
Liver (13%)
Lung (13%)
Asian countries share
Breast (7%)
more similarities in
Colorectal (7%)
Breast (5%)
Liver (7%)
disease patterns
Esophagus (12%) Colorectal (9%)
Breast (6%)
Cervix (4%)
Prostate (5%)
Breast (14%)
H&N (3%)
Leukemia (3%) Esophagus (2%)
11%
5%
35%
Lung (13%)
NHL (4%)
14%
32%
Colorectal (8%)
Melanoma (4%)
Pancreas (4%)
Kidney (4%)
Gall / Bile duct (3%)
Bladder (3%)
Source: Clinical Trials in Asia Pacific – New Challenges and Opportunities, Partnerships in
Clinical Trials Asia Pacific (Singapore, 02 DEC 2009); American Cancer Society, 2015
23%
21%
9%
12%
2% 8%
9%
3%
2%
9%
15%
8%
8%
20%
3%
7%
15%
2008
12%
13%
Western Pacific
9%
2008
H&N (3%)
35%
Prostate (13%)
28%
Liver (16%)
34%
2030
ASEAN
2030
Cardiovascular disease
Infectious disease, malnutrition
Cancer
Injuries
Respiratory disease
Diabetes
Others
Source: Leveraging ASEAN market,
Researchpartnership.com
Client Confidential – Do not share
42
Why Japanese Pharma have advantages
❷ Advantage of multinational clinical trial design in Asia for faster
regulatory approvals
Ethnic similarity allows Japan pharma to design collaborative trials and shorten the launch gap in these
markets
The bottom-left illustrates a therapeutic area where the highest level of ethnic difference exists.
- Considerable ethnic difference between East and West, which often result in differences in clinical
practice, guideline, dosage, active control, concomitant drugs
- Even in this situation, clinical studies can be co-designed in Japan and Asia at the same thanks to low
genetic diversity (illustrated in the Bottom-right), ultimately shortening the time for Japan-focused trial
sponsors to enter the Asian market than Global sponsors who proritise US and EU market.
Fully Separated Clinical Study Collaboration
Origin of
Clinical
study
Collaborate-ability between regions
US, EU
Phase 1
Japan
Phase 1
Asia
Phase 2
Phase 3
Phase 2
Phase 3
Genetic diversity is
limited within the
region due to close
proximity
Arrows indicate genetic diversification flows
Source: Tetsuomi Takano, New Strategy on Multinational Clinical Trials in China and Japan in Consideration of Ethnic Factors, JPMA
http://www.pmda.go.jp/files/000152237.pdf
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43
Why Japanese Pharma have advantages
❸ High awareness of Japanese brands & Geographical/Cultural relatedness
Comparison of Top 60 Brands in Global VS Asian region
Adidads
Jaguar
Adidas
Amazon.com
Johnson&Johnson
Ajinomoto Mercedes-Benz
American Express
Lexus
American Express
Apple
LG
Apple
AT&T
L'oreal
BMW
Audi
MasterCard
Canon
Nestle
Bayer
McDonalds
Citibank
Nike
Berkshire Hathaway
Mercedes-Benz
CocaCola
Nikon
Nissan
10% of
McDonald's
Microsoft
Mitsubishi
Electric
Muji
35% of
Japanese
Japanese
Daihatsu
Brands
in
Nissan
Brands
in
Epson
Panasonic
BMW
Michelin
Bridgestone
Microsoft
Cadillac
Chevrolet
Nestle
Nike
Cisco
Colgate
Nivea
Danone
Dell
Nokia
P&G
Japanese companies could be benefited from high
awareness of Japanese brands stemming from
consumer products/electronics in the region (Left
illustration)
Especially large conglomerates with healthcare
divisions could enjoy an existing share of voice
Geographical proximity and similarity across
cultures and business practices between Asian
countries and Japan lower the operational
challenges of international strategy development
and implementation from HQ (Bottom illustration)
Global Top VS AsianSharpTop
CocaCola
Disney
Nivea
Novartis
Gap
General Electrics
Ernst & Young
P&G
Google
60 Most
Popular
Brands in
2014
Shiseido
60 Most
Hitachi
Sony
Popular
Honda
Brands
in
Suzuki
Toshiba
2014
Toyota
ExxonMobil
Pepsi
H&M
Facebook
Philips
Haagen-Dazs
Ford
Porche
General Electric
PwC
Google
Samsung
Gucci
Shell
H&M
Siemens
Philips
Samsung
Starbucks
HP
HSBC
Hyundai
Sony
IBM
Unicharm
Starbucks
Johnson&Johnson
Unilever
Toyota
Kao
Uniqlo
Twitter
Kellog's
Visa
IBM
Unilever
KFC
Xerox
Infiniti
Visa
LG
Yahoo
Intel
Volkswagen
L'Oreal
Yamaha
Hershey's
Honda
HP
HSBC
Formal,
structured
business
setting
Siemens
Source: Brand Asia 2014 Survey Results, Nikkei BP Consulting,
Ranking The Brands Top 100 www.rankingthebrands.com
Processoriented
Generating profit
Humility,
patience,
harmony
Commonly shared corporate
goal (●) and operational
considerations (○)
Indirect
communi
cation
Team
credit
Asia
Casual,
less
distant
business
setting
Direct
ResultCreating
commuoriented
Sharenication
holder
value
Confidence,
Personal
demonscredit
trativenss
West
Source: How to Crack Asian Business, 2011, Fortune
21 Cultural Clues for Doing Business in Asia, 2013, The Business Journals
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44
Dynamic landscape: Increasing political investments and HTA
evaluation processes will create greater market opportunity
HTA dynamics
High
uncertainty
Significant changes
matched with
political commitment
Relatively
established,
HTA to be
accelerated
Client Confidential – Do not share
Health insurance
coverage dynamics
45
Country Key Take-aways
Indonesia: Where will the UHC spending priorities be by 2019?
Thailand: With UHC established, where next?
Singapore: Maintaining its position as key market entry node?
Malaysia: Is the current model sustainable?
Philippines: Would further price cuts be mandated to achieve UHC?
Vietnam: Will the price gap between brands and generics narrow?
Client Confidential – Do not share
46
ASEAN Region
A 650 million people economy potential!
Member countries
Indonesia
Philippines
Thailand
Vietnam
Myanmar
Malaysia
Singapore
Brunei
Darussalam
Lao PDR
Cambodia
Client Confidential – Do not share
47
Why does Asia / ASEAN matter?
ASEAN Regional trends
Concept Overview
Country Discussion
Conclusions and Business Opportunities
Deallus Introduction
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48
About Deallus Consulting
www.deallusconsulting.com
Deallus Consulting improves your strategy by developing, testing and refining the key market
assumptions that underpin it. We can do this because of our focus on the Life Sciences
industry, our efficient and comprehensive research and our rigorous analysis
Deallus Consulting
Deallus Global Footprint
Was Founded in London in 2004 with offices in New
York, Princeton, Los Angeles, Singapore, Tokyo and
dedicated, exclusive support in China and LATAM
Has completed over 1,000 assignments
Has over 80 Consultants
Is a Life Science specialist, with more that 80% of
our Consultants possessing a Life Science PhD
Has >90% client retention, (clients we continue to
work with since our first engagement)
Supports any decision maker or manager involved
in strategy development, right across the Product
Life Cycle, in the largest multinationals or SME’s at
Global, Regional and Affiliate level
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49
Deallus Consulting
What We Do
www.deallusconsulting.com
Deallus’ best in class competitive
analysis is based on rigorous
research and analysis to test and
refine the assumptions, to ensure
winning strategies based on a
robust understanding of the market
Deallus’ expertise in strategic
management consulting spans a
range of services across product
lifecycle, in strategy development,
in business development, brand
management, market access and
manufacturing and supply chain
Deallus has extensive experience in
effectively leading and
implementing competitive
workshops consistent of scenario
planning workshops, war games,
individualized training programs and
hybrid models
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Deallus has supported its clients in optimising robust market entry
strategies for the Asian markets
Asian market strategy must take into account all factors affecting the market’s true potential
• What is the total number of
patients in each indication
• What is the number of eligible
patients in each indication
•
Patient
Population
Dynamics
• What are the regulatory
requirements for approval
• What are the regulatory timelines
for approval in each market
• will post registration activities
be required
• What are the pricing and
reimbursement requirements for
each indication in each market?
• How does the pricing differ
depending on setting of care?
• What are the pricing timelines?
Healthcare
Landscape
•
•
How well developed is the
healthcare infrastructure for each
indication in each of the markets?
What is the treatment pathway for
each indication in each market?
Who are the key influencers in each
market?
•
Product
Registration
and Launch
•
Competitor
Landscape
•
Pricing and
Market
Access
Sales and
Marketing
Strategy
•
•
•
Client Confidential – Do not share
•
Who are the key competitor
in the market?
What is the competitor
strategy and impact on
your company?
What is the competitor
market share vs your
market share?
What are the winning sales and
marketing strategies tailored for
each market?
What is the product penetration per
account?
Who are the key stakeholders to
target per indication per market
The drivers and strainers of growth
within each market?
51
Deallus Consulting
Who We Are
www.deallusconsulting.com
Our Presence in Asia builds on a strong foundation of Project Management from JPAC HQ, with
on-the-ground support from local consultants
Carole Bruckler, PhD
Ichiro Masuda
Partner, Head of Japan &
Asia Pacific
Principal, Head of Japan
Operations
Anousha Kamvari, PhD
Feng Wang, PhD
Senior Consultant, Singapore
Consultant, Tokyo
3
Ju Hyoung Lim, PhD
Hiroyuki Onoda
Consultant, Singapore
Associate, Singapore
Tom Chang, MBA
Budiman Jimron, MSc
Associate, Singapore
Associate, Singapore
Carl Qian, PhD
Michael Lee
Associate, Singapore
Business Analysts, Singapore
Alicia Yang Jenkins, PhD
Supported by other
Local Researchers
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52
Deallus Consulting JPAC Team
Carole Bruckler, PhD – Partner, Head of JPAC
Carole Brückler is the Head of the Deallus Consulting Japan & Asia-Pacific operations, based in Singapore. She
has led client engagements developing regional or global product strategy for 9 of the top 10 global pharma
companies. Carole’s clients assignments have enabled business decisions reflecting market evaluations of new
products and acquired assets, pricing and reimbursement challenges, generic and biosimilars entry and landscape
assessments to validate opportunities present existing portfolios. Carole’s experience covers multiple therapy
areas, particularly Vaccines, CNS, CVM and respiratory field, as well as medical devices field.
Prior to setting up the Asia Pacific operations for Deallus consulting, she led the established European business.
Carole has also lectured at multiple Pharma industry conferences on the challenges of conducting research in the
vaccines area, in Europe, US and China. Prior to joining Deallus, Carole worked in preclinical R&D, both in a
synthetic organic setting, as well as an analytical setting in support of asthma treatments at GSK. Carole
completed her PhD in Chemical Biology at the University of Edinburgh. Carole is a joint inventor and patent holder
of this technology. In addition to her academic qualifications and professional credentials, Carole speaks several
European languages.
Ichiro Masuda – Principal, Head of Japan Operations & Representative Director
Ichiro Masuda is the Principal, Head of Japan Operations and Representative Director in the Deallus Tokyo Office.
Ichiro joined Deallus with 27+ years of experience in sales, marketing, marketing research, business development
in the pharmaceutical industry.
He spent 21 years at Eli Lilly Japan in progressively senior sales, marketing and product management roles,
before he moved to the consulting industry. At IMS Consulting, he worked in the Commercial Practice, delivering
market optimisation, resource allocation and marketing training projects. At ZS Associates, he developed the area
of strategic market research in ZS Tokyo and worked on forecasting and business development assignments,
while managing business development and client engagements.
Ichiro is a graduate of Kyoto University in Economics, a nationally registered management and healthcare
consultant, as well as a native Japanese speaker.
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53
Deallus Consulting JPAC Team
Anousha Kamvari, PhD – Senior Consultant
Anousha is a Senior Consultant based at our Singapore office. Anousha offers broad experience across both the
medical device and pharmaceutical industries. Her areas of expertise include strategic and operational leadership
in market entry, market analytics, pricing and reimbursement, regulatory (FDA, EMA, CFDA) and compliance
systems for medical devices including drug-device combination products and pharmaceuticals.
Prior to joining Deallus, Anousha was instrumental in advising senior management at BTG, an international
specialist healthcare company, on go no-go business case investments for multiple brands across the
Interventional Oncology franchise; at both a regional and global level.
Anousha holds a PhD in Biomaterials Engineering from University of Cambridge and a 1st class honours MEng
degree from Queen Mary University of London. She has authored two book chapters within the field of
Biomaterials Engineering.
Feng Wang , PhD – Senior Consultant
Feng is a Senior Consultant at Deallus Consulting Tokyo office, recently transferred from Deallus Global
Headquarter in London. He joined Deallus London in 2011 and since then, he has led client engagements across
wide therapy areas (Oncology, Vaccines, Urology, Ophthalmology & Biosimilars) at product and portfolio level. His
prior and ongoing projects support top 20 MNC including Japanese pharmaceutical companies in competitive
landscape analysis, product launch preparation, commercial structure benchmarking, emerging market entry
strategies as well as clinical development and new product planning. His market expertise covers EU, US and
Emerging Markets in Asia.
Feng holds a PhD in Oncology from the University of Cambridge examining the mechanism of chemotherapy
resistance in ovarian cancer and an MBioch from the University of Oxford. During his PhD, he also developed
commercial knowledge through pharma-sponsored workshops and Technology Management course at Cambridge
Judge Business School. Feng speaks English, Mandarin and basic Japanese.
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54
Deallus Consulting JPAC Team
Lim Ju Hyoung, PhD – Consultant
Ju Hyoung is a Consultant at Deallus Consulting, Singapore. Since joining Deallus, he has led a broad range of
projects covering Korea, China, Japan, Australia, South East Asia, as well as Europe, supporting clients by
providing bespoke insights in various therapeutic areas including infectious diseases, oncology, autoimmune
diseases, orphan diseases, etc. In addition, he has worked in a number of projects with extensive focus on
biosimilars, vaccines, aesthetic products.​
Ju Hyoung has earned a PhD in Biological Sciences from Korea Advanced Institute of Science and Technology
(KAIST) and completed a postdoctoral fellowship at Massachusetts Institute of Technology (MIT). He also spent
considerable time working with Korean biotechnology start-up companies, consulting on process optimization
projects, as well as managing collaborations with government departments to develop research proposals and
assess the commercialization potentials of these projects. He is a native speaker of Korean, and is fluent in
English.
Hiroyuki Onoda, BPharm – Associate
Hiroyuki Onoda (Hiro) is an Associate in the Deallus Singapore office. At Deallus, Hiro has supported a wide range
of projects ranging from R&D strategy, marketing strategy and competitive landscaping to supply chain optimization.
Hiro brings in-depth insights from the Japanese market to multiple projects, bridging cultural gaps and engaging
with Japanese client teams. His research and analysis has covered multiple therapy areas (oncology, hepatology,
gastroenterology, CVM & CNS) as well as vaccines and biosimilars.
Prior to joining Deallus, Hiro worked as a marketing specialist at Suzuken in Japan, the third largest domestic
pharmaceutical wholesaler, developing expertise in sales, promotion and physician engagement for a wide range of
pharmaceutical products across therapy areas, both branded and generic, including vaccines and diagnostics.
During this time he developed a deep understanding of the supply chain, sales and marketing and the Japanese
healthcare system through working with a variety of pharmaceutical companies in highly competitive environment.
Hiro is bilingual (Japanese/ English), holds a B.S. in pharmaceutical sciences & is a registered pharmacist in Japan.
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Deallus Consulting JPAC Team
Budiman Jimron, MSc – Associate
Budiman is an Associate at Deallus Consulting, Singapore. He has earned a Masters in Integrated Biosciences
from the University of Tokyo, and had considerable working experiences with Japanese consultancy firm on
market entry strategy for Japanese companies in South East Asia.
Since joining Deallus, he has worked on projects covering Indonesia, Malaysia and other APAC countries,
supporting research efforts into various therapeutic areas such as diabetic nephropathy, vector-borne diseases,
etc. He is a native speaker of Bahasa Indonesia, and is fluent in English and Japanese.
Tom Chang, MBA – Associate
Tom Chang is an Associate in the Deallus Singapore office. He is an MBA graduate of Hitotsubashi University,
Graduate School of International Corporate Strategy in Tokyo, Japan. He received his BSc from University of
British Columbia (UBC) in Vancouver, Canada.
Tom has worked in the technical side of pharmaceutical companies and brings a unique perspective of drug
development and product planning. He has experience in the Japanese Generics Market through an internship at
Mylan Seiyaku (Pharmaceutical) Ltd., where he was assigned to assist on three products, one product line
expansion and two product developments for antipsychotic and migraine attack treatments. Tom speaks English,
Mandarin and Japanese.
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Deallus Consulting JPAC Team
Carl Qian, PhD – Associate
Carl is an Associate at Deallus Consulting’s Singapore office. Since joining Deallus, he has worked on multiple
projects covering Asia Pacific and the US, supporting clients in fields such as oncology, infectious diseases,
vaccines and drug manufacturing.
Carl graduated from the PhD program in Mechanobiology from National University of Singapore. His PhD research
area was in computational biophysics. He holds a Bachelor of Science in Biological Science and a minor in
Computer Science from Fudan University in China with a thesis focusing on Breast cancer genomics. He also had
internship experience at Novartis Institute of Biomedical Research, working on antibody-based biomarker
discovery. Prior to joining Deallus, he was an Associate at SingTel Group in its Tel Aviv office, working on
innovation and business partnerships in the high-tech sector. He is fluent in English and Mandarin Chinese.
Michael Lee, MSc – Business Analyst
Michael is a Business Analyst at Deallus Consulting in Singapore. In his time with Deallus, he has been involved in
multiple projects with a primary focus in China and the rest of APAC region. Michael’s therapeutic area expertise
include virology, digestive diseases, infertility, oncology, metabolism diseases, and cardiovascular diseases.
Biosimilar and generic drug markets are two major focuses of his recent researches. Michael’s studies on
competitor dynamics monitoring, potential trends prediction, business development support, regulatory policy
research have supported commercial decision making.
Michael holds a Master of Science degree in Biochemistry and Molecular Biology from National Cheng Kung
University, Taiwan and specialized in cancer biology and metastasis mechanism. Before joining Deallus, Michael
worked on business development and training services at PPC, the leading domestic clinical research organization
in Taiwan. He also has internship experiences at Vita Genomics, Inc. and NanKang Biotech Incubation Centre on
marketing and industrial development strategies analysis. Michael is fluent in Mandarin.
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Acronyms
AEC
ASEAN
FDI
GDP
NCD
OOP
SHI
THE
UHC
ASEAN Economic Community
Association of South East Asian Nations
Foreign Direct Investment
Gross Domestic Product
Non-communicable diseases
Out of Pocket
Social Health Insurance
Total Health Expenditure
Universal Health Coverage
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