Julian Upton

David Sanders, vice president of government affairs & policy at biosimilars company Coherus BioSciences, speaks on the firm’s goal of expanding patient access to cost-effective medication, and his role with Securing America’s Medicines and Supply, a coalition of companies aiming to strengthen the security of the US medical supply chain.

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Biopharma firm strives to deliver savings to the US healthcare system

Prioritizing American Manufacturing

Over the last two and a half years, UPS Healthcare has been growing its services in Europe. In May 2020, for example, the company opened an air freight forwarding facility in Amsterdam, The Netherlands. In March 2021, it announced it was investing in a new state-of-the-art logistics facility in Rome, Italy and recently confirmed plans for more facilities in Germany and Poland. In October that year, it announced the European expansion of its technology-enabled express delivery service, UPS Premier. And at the same time, UPS opened its first dedicated healthcare logistics facility in Ostrava, Czech Republic.

Graham Cromb is responsible for the UPS’ healthcare distribution business across Europe. Starting his UPS career in Toronto, Canada, in 2000, he has been based in Brussels, Belgium, for the past five years. 

caught up with Cromb recently to discuss how the COVID-19 pandemic fueled the company’s expansion in Europe, and where UPS is heading in the post-COVID landscape.

Pharma Commerce: What have been the challenges and successes of UPS’ COVID vaccine distribution journey?

 The challenge, of course, was knowing how important it was to deliver vaccines on time just with the highest level of quality. At UPS, certainly, we marshalled significant resources to map the 500 or so global trade lanes we used for delivery, which were more complex and longer than as an industry we were used to. At the same time, we were deploying a new technology, a new sensor technology that allowed us, really for the first time in our small package business, to understand where any package was within a 3-meter or a 10-foot radius, which is very helpful in the event that you need to re-route or re-plan vaccines. We accelerated that program and rolled it out on a global basis and it helped us to deliver at an incredibly high rate of on-time performance.

Of course, there was a useful timing element in that the business started in the months just prior to the pandemic hitting. We acted very quickly, really focusing on the cold chain infrastructure at the global level. Then, when the vaccines were ready, we were also ready from that infrastructure standpoint. I'm proud of how weve participated and supported people and patients during the pandemic. I guess the best testimony to that is that we had delivered, by December 2021, more than 1 billion vaccines at 99.9% on-time.

How did the company achieve equitable distribution to remote and rural areas?

Our customers, be they manufacturers or government, ultimately dictate where the vaccines are going to go. But our experience thus far has seen us deliver to about 110 countries across five continents. We‘ve been actively participating with organizations such as the vaccine alliance, Gavi and COVAX, etc., to deliver to underserved countries. For example, we delivered 330,000 vaccines, largely by drone, to rural clinics in Ghana late last year, and we provided to-date delivery of over a million vaccine doses in Nigeria. We also donated well over 200 of the ultra-cold freezer (ULT) units to underserved populations in Africa and Europe and elsewhere. We‘ve been very active in terms of just helping to ensure equitable distribution.

What are the broader logistics issues across Europe? How do you navigate countries with differing interpretations of regulations and compliance?

We’ve got a strong network of distribution facilities throughout Europe and are continuing to expand our active cold chain fleet. This allows us to become experts on a country-by-country, market-by-market basis, so we are in a position to be able to advise customers about the best way to organize their supply chains.

With new crises hitting Europe post-COVID, what do you see as the cold chain challenges of the next few years?

We know that cold chain is only going to grow. And it‘s going to grow at a tremendous pace year-on-year. Cold chain has been around for a long time, of course, but that's not to say it‘s easy. There are challenges, certainly, to do with the infrastructure and multiple temperature ranges. Since the inception of our UPS healthcare business just over two years ago, we‘ve been investing. We've built out our distribution centers across Europe for active cold chain delivery. And we've been building out our cold chain ground network from a distribution and warehousing standpoint, right through to final-mile delivery.

How are new technologies transforming pharmaceutical distribution?

It comes back to the complexity of cold chain in particular—how do you simplify that? Certainly, the customers that we serve are looking for that simplicity, which can start with visibility and analytics and the accessibility of data. That’s all well and good, but I think we‘re at a point now where you can bring information together in a way that's affordable to the marketplace. That just wasn‘t the case, say, 10 years ago. Because that can be done, we can offer a truly end-to-end service. A company like UPS can provide all of the data, the analytics, and the ability to leverage those analytics through technologies that are new and accessible in a way they weren‘t before. And if we look at packaging, for example, today we are more focused than ever on working with suppliers to advance packaging technologies to be more sustainable and to hold temperature over longer periods of time.

It’s interesting that you mention sustainability. There was a lot of discussion at the recent LogiPharma event about that. What else is UPS Healthcare doing to address the environmental issues surrounding pharma distribution?

We work with customers, either on an individual basis or in tailoring some of our joint programs, to deliver improved sustainability. A lot of it comes back to a blend of active versus passive temperature control. We look for continuous improvement and we measure it. Today, we measure the success of our partnerships to a large extent in terms of sustainability. By 2050 we are of course looking to be carbon-neutral; from an interim standpoint, by 2035 we're looking for 50% reduction in CO2 per package delivered from our global small package operations and by 2035, we are also aiming to be fully powered by renewable electricity. Those are just a few examples of what we‘re doing.

UPS: Continuing to expand its healthcare fleet

Articles

Graham Cromb, Vice President of Europe Operations at UPS Healthcare talks about how the COVID-19 pandemic fueled UPS’ expansion in Europe, and where the company is heading in the post-COVID landscape

Timing is Everything: Graham Cromb, UPS Healthcare

Dennis Wright, senior director of product marketing at Omnicell, a company that provides both a medication management platform along with technology-enabled services, discusses the ongoing issue of medication nonadherence and efficient ways to utilize pharmacists’ expertise in an effort to create an effective supply chain.

How this link in the supply chain can help alleviate healthcare challenges

Re-evaluating the Role of the Pharmacist

Adham Yehia, co-founder and COO of DrugStoc, a cloud-based pharmaceutical distribution platform that is working to assist healthcare providers (HCPs) across Africa by connecting manufacturers to hospitals and pharmacies, outlines his inspiration for founding the company, along with the logistical obstacles that come with distribution.

How a company empowers HCPs through its consolidated supply chain system

Providing Medication Access to Africa

, the first for me as the publication’s editor. As former Editorial Director Michael Christel indicated in his introduction to the last issue (February), his recent promotion to a new role at 

’s parent company, MJH Life Sciences, now takes him away from the day-to-day oversight of the magazine; however, as group managing editor, Mike will still be playing a major part in informing and shaping 

s content. I look forward to working with him to maintain the quality and consistency he and Associate Editor Nicholas Saraceno have brought to the publication since it became part of the MJH stable in June 2020.

Over the last couple of years particularly, many trade and B2B magazine editors have had to juggle, assess, and prioritize the assorted contributions for any particular issue without leaving their desks, but I know from experience that I’ll need to get into the weeds a bit more in the coming months, interviewing experts and getting out to conferences to really understand the 

world and the latest thinking around it. Fortunately, the climate for industry events is improving again and in-person conferences are making more of a return in 2022. On that note, I’ll be attending LogiPharma in Nice, France (April 5–7), which looks to offer a thorough and expansive introduction to the current challenges and opportunities prevalent in the global pharma supply chain space. I look forward to harnessing some of the ideas and expertise from that show to inform our upcoming issues; I also hope that this and other events give me the chance to catch up with some of 

’s readers, contributors, and would-be contributors to keep those ideas coming!

e, I’m no stranger to the term “patient centricity.” But in familiarizing myself with some of the thinking and practices around this month’s focus on patient support and hub services, I realized that I’d perhaps fallen into some of the lazy thinking around the idea of “the patient” that has arguably prevented pharma companies from radically advancing their patient-centricity strategies since the term was first mooted well over a decade ago.

 was to speak to the editors/co-authors of a new book from global professional services firm ZS called 

. I found this conversation with Hensley Evans and Sharon Suchotliff somewhat revelatory, not least in their suggestion that the word “patient” itself might have run its course, with growing calls from the advocacy community for a term that carries less stigma and promotes a more human view of those who are suffering from a particular condition or diseases. More immediately impactful, though, is Evans and Suchotliff’s benchmarking of a number of pharma firms that reveals no company has yet implemented any real “transformational change” in the patient-centricity space, and their argument that some of the patient-support advances brought about by COVID-19 were not only very implementable well before the pandemic, but were also well known to be implementable.

All of this, of course, leaves room for patient support/hub services providers to expand their efforts to further “humanize” patients in the eyes of the pharma industry and to encourage improved offerings that 

 take the patient’s needs into account. As Evans and Suchotliff conclude, their aim is not to disparage pharma but to expand the scope of the conversations around patient centricity and to truly “make it a reality.”

Julian Update is Pharmaceutical Commerce's Editorial Director. He can be reached at

PC's new editor-in-chief details his thought process on familiarizing himself with a different side of the industry

Diving in Headfirst

Whlie the pharma world has been talking about patient centricity for over a decade, a new book points out that executives and companies have only made piece-meal progress on this issue and have yet to deliver on their promise to hold the patients’ needs at the center of all decisions. 

, edited and co-written by Hensley Evans, leader of ZS’ patient and consumer health practice, and Sharon Suchotliff, who heads ZS’ patient centricity work, explores how pharma can move beyond just implementing what they call a “patient-centered corporate culture.” The editors and their contributors use real-world case studies, proprietary data from a range of studies, and insights from their own experience to offer tangible ways for pharma companies to make an impact on patient lives, from initial R&D stages, through to effective clinical trials and enhanced patient engagement during treatment.

Before joining ZS, Evans led consumer and patient marketing strategy at Saatchi & Saatchi Health and Wellness; she also spent eight years leading imc2’s health and wellness practice and four years as president of Harte-Hanks Direct and Interactive.

Prior to her role at ZS, Suchotliff led the engagement strategy practice at Saatchi & Saatchi Wellness, where she was responsible for developing and leading strategic marketing across the agency’s pharmaceutical, healthcare, and wellness clients.

 sat down with Evans and Suchotliff to chart the book’s development and tap into their vision for a future where patient centricity is not just a buzzword or a hackneyed term but a tenet embedded at the heart of the industry.

. “Reinventing” is quite a strong word, quite provocative. Does patient centricity need to be reinvented, and what would that reinvention actually mean?

 The reason we use the word “reinvention” is that we did want to be a bit provocative. We’ve been talking about patient centricity in the industry for a really long time. I think it was 2010 when UCB put on the cover of their annual report that they were going to be the leader in patient-centric pharma. But our benchmarking studies of where pharma is in terms of implementing patient-centric initiatives has shown that no one is transformational. Companies are instead making very incremental changes, moving their business models toward one that’s more focused on delivering to patient needs and being patient-value oriented. So, we wanted to issue a bit of a challenge to the industry to take more meaningful steps to transform their organizations toward a patient-focused way of doing business.

We looked at patient centricity, how companies are actualizing it, based on four dimensions (see chart on next page). We’ve benchmarked more than two dozen companies over the last few years. As Hensley says, no one is transformational. By and large, the industry is really foundational. We have seen changes over the last few years, but not enough. If we truly believe in patient centricity, we’ve got to change the way things are done. And we’re asking, “How might we do that? How do we walk away from the buzzwords? How do we make this meaningful and real?”

It does indeed feel like we’ve been talking about patient centricity for a long time. I’m surprised it’s only 10 or 12 years. So, we can ask, is that a long time, really? Haven’t we had to wait for technological advancements to really allow for patient centricity?

 I think technology has a lot to do with it. We now live in the “I want what I want when I want it” world. That’s been facilitated by personalization, and, of course, data and technology have helped to drive that. But there are other reasons. There’s the external environment, there are also business reasons, in terms of the decline in the return on investment of clinical development. And there is the fact that specialty and rare diseases, oncology, personalized medicine, gene therapy—all of these require a more focused and a better understanding of patients. We’re also seeing a shift in the regulatory environment. Both the European Medicines Agency (EMA) and FDA are asking for patient input. In the next couple of years, we can expect the regulators will want to see more of this input. And on the payer side, we’re at a place where payers are looking for value beyond clinical outcomes. Are patients better able to engage in their life? Do we see a reduction in overall healthcare costs? So, I think there’s a lot of different reasons that have led to this change.

 Technology is a great enabler, so I was a little disappointed when we did the benchmarking last year to see that we hadn’t come further as a result of the incredible leap that we’ve made in terms of data and technology. And COVID pushed the pedal down further in terms of accelerating technology adoption. I don’t think that the lack of technology was what was holding pharma back. We talked to executives on our advisory board and they listed things like silos, concerns about regulatory issues, compliance. And yet I think the single-biggest reason is that pharma has been phenomenally profitable and successful for decades, if not more than a century, without having to make a radical change in this way. It’s kind of the “If it ain’t broke, don’t fix it” approach. There’s no burning platform to make companies adopt a radically different approach to their business. But a lot of the things that Sharon mentioned are driving senior executives to think, “Yeah, maybe I’d better start moving off this platform before it’s really on fire,” so I’m hopeful that we’ll see some more dramatic change.

We hope that by writing the book, we’re going to help push some of the folks who are behind the leaders to move more quickly. It’s doubtful that anyone who’s not already thinking about patient centricity would bother to pick up the book in the first place, but we are trying to preach beyond the choir, to reach a broader audience and move beyond the apple-pie notion that “Of course, patient centricity is a good thing.”

 You can have the best strategy, the best intentions, but without a focus on shifting the mindset, you’re dead in the water. I think a big cultural shift has to happen, and a lot of it has to be around what we believe and how we define value. Can we get to a place where value to the patient equals value to the company? I think that’s the biggest change, and it’s one that pharma’s coming around to very slowly.

 A company can say, “I want to improve the experience that a patient has starting my therapy.” Primarily, that is a business objective—to get patients on a therapy faster. A delay of two to three months has a significant business impact. If a company delivers a much smoother and more pleasant experience to its patients, those delays and barriers can be eliminated; the patient appreciates it. It’s kind of a win-win. But if it’s only done for a business reason, then a company is only solving things in little silos, e.g., decreasing the patient burden in your clinical trials because, otherwise, patients are going to drop out or fail to enroll.

There has to be a cultural or mindset shift, or you are only ever going to get incremental change.

What did your collaborators bring to the book?

 Everyone that we approached early on about collaborating on the book was hugely enthusiastic. One of the reasons we decided to write it in the first place was that we had so many different parts of the organization focusing on different aspects of patient centricity: the data and technology team; the digital connected health team; the rare-disease vertical focused on partnering with patient advocacy groups; the R&D excellence team looking at clinical development. ZS is a very entrepreneurial organization. We have lots of practices that are really able to innovate and independently develop solutions. We thought it would be a great way to bring together a group of people that are looking at different ways to help the pharma industry really evolve and change.

 One of the things that I really like about working at ZS is that on one hand, we have lots of innovation—big thinkers, folks who are really willing to challenge the status quo—and at the same time, there is this recognition that we’ve got to be a bit pragmatic. That was a big driver for us in terms of the book. In having conversations with many executives, sometimes the patient-centricity ambitions just seem unachievable, too lofty. We wanted to present the pragmatic ideas, the pragmatic solutions, so that folks can see they’re taking good steps. But we also invited a lot of external folks to contribute, so sometimes we heard things that were hard to hear, but that’s okay, right? I think it made our work better.

 An early piece of feedback we got, actually from one of our patient advocates, was, “Do you guys have a group of patients that you work with consistently to get feedback on the work that you’re doing?” Of course, we advise our clients all the time to get patient input and take the patient perspective, but we kind of sheepishly said, “Um, no.” Well, now we do. The time it takes to publish a book gave us time to stand up a patient advisory panel. So, we learned a lot along the way; challenges from some of our collaborators caused us to do a little bit of rethinking.

 One interesting question we wrestled with, honestly, was around the use of the word “patient.” The industry, of course, has used this word consistently for a very long time. But most of the patient advocates we spoke to don’t like to refer to themselves as patients. They’re people; they’re more than someone who suffers from any particular condition or disease. We debated quite a bit about whether we should try to change the language that’s used around patient centricity.

But ultimately, we decided we’d reach a larger audience if we used the language that most people are kind of comfortable with or use now.

The book was being written as the COVID-19 pandemic was raging. What impact did that have on how the

 It changed a lot. To some extent, it made it easier to collaborate because, all of a sudden, we’re working in this virtual world. Collaborating virtually became second nature. And of course, in terms of the information we were including in the book, COVID certainly changed things.

 Yes, we had one conversation with an organization during COVID who put in place a mechanism to provide home care for patients because, of course, patients were unwilling to go to the physician’s office. And I said, “That’s great; it that a new insight that came up?” But they said, “Well, we always knew that patients didn’t want to have to go to the doctor’s office. It was always inconvenient for them. But they used to do it anyway.” So, it was only when patients insisted on not doing it that the company started accommodating them. Now, I don’t know that I want to call that patient-centric, right? It’s self-centered. The company only did it because it was hurting them financially, even though they knew that the patients would have preferred that all along. That was quite revealing.

How do you see the book being used? Will it become part of ZS’ package for clients or something independent

 In many ways, the book synthesizes a lot of thought leadership we had already been working on. Our company vision is “transforming global healthcare, driving toward a connected ecosystem, leveraging the power of data, science, and technology to make more intelligent healthcare decisions, and delivering innovative solutions to improve health outcomes for all.” The focus really is about patient outcomes and having an impact. At our partner meeting last August, which was exciting because it was the first time we’d come together in two years, our CEO held up the book during his keynote speech and said, “This really represents the thinking across the firm.” Everybody feels that the patient and patient outcomes are a critical orientation of our company as a whole.

 is also a book in its own right. And I hope it helps us to create some new conversations, particularly with more senior executives. One of the things we see is that there are some incredible evangelists for patient engagement and patient centricity at the senior director and VP level. But if a pharma company doesn’t have vocal SVP and c-suite leaders really pushing patient centricity, they’re only going to get so far.

We’d like to expand the scope of the conversations we’re having with the c-suite about patient centricity and how to make it a reality.

New book attempts to cut through pharma’s patient-centric posturing and start a conversation about real, transformational change