Between Medicine, Research and Policy

Isabel talking to a man

Looking at what's behind the everyday hospital system, questioning rigid structures and rules – this is what Isabel Henkel has been interested in as early as during her residency. An anesthesiologist, she left the hospital environment for a successful career in industry. At Roche, she is currently working at Market Access. She leads a team of 75 employees that shares the responsibility for reimbursement of medications in the German healthcare system. Here she explains why it takes people with a spine, creativity and innovative thinking to thrive in this area, to Nicolai Haase, Editor-in-chief of arzt & karriere.

Hello, Ms. Henkel, you work at Roche's Market Access. What exactly is it that you do there?

We are tasked with obtaining market access for new medications in order to make them accessible to patients, and to secure reimbursement through the German healthcare system. In order to do so, we have to show that a medication has an additional benefit over existing therapeutic methods. Basically, the new product must have a greater benefit for the patients than the products that have been available in the market so far.

Can you explain that in more detail?

Roche has a full pipeline; i.e., the company is doing research on numerous products globally that are on track for regulatory approval. We already look at a drug during an early development phase and provide our assessment of whether there is a need for a certain product in the German market at all, and if so, how ideal market access can be achieved. For this purpose, we have our own department within Market Access, and we work closely with our international colleagues.

Have you always wanted to have a career in the medical field?

Yes, I was always sure that I wanted to become a medical expert. However, I was not immediately admitted to study medicine, and so I first studied some macroeconomics, then biology as well as physics and mathematics in preparation for a teaching career – but I was very happy to finally be admitted to study medicine, for math was really hard (laughs).

What did you do after your medical studies?

 I graduated in Berlin and then found a job relatively quickly as a junior resident in Anesthesiology at the Uniklinik Berlin. Later, I went to work at the “Unfallkrankenhaus” (trauma surgery) that was scheduled to be launched at the time.  This allowed me to experience a totally different facet of medicine. I spent a lot of time hanging out with the architects. We discussed issues such as the construction and planning phase for the hospital.  That was very new to me as a junior resident, but I noticed right away that this paramedical level piqued my interest.

And you then followed your curiosity about these issues?

Yes, I started studying public health in Berlin, in addition to doing my residency. These issues were the subject of my studies. For example, we had a class on urban planning: What noise levels or wind conditions do architects have to take into account when planning a building for a young family or for a retirement home? I found that extremely exciting. In this course of studies, I also learned about the health-policy level, about which you don't really know anything when you work at a hospital. Who decides what and why? You absolutely have to enter the system sector in order to be able to understand the interaction. And that was the opportunity industry offered at the time.

So your studies were the reason for your decision to exit hospital work and enter industry?

I knew that I wanted to use what I had studied for my career, but after I had completed my residency, I first practiced an "exit lite" by working in the organ donation field next. My work there already had an organizational system component; i.e. while I was caring for patients at the hospital, I also took part in training courses and worked on raising awareness.

Did you actually like working as a physician?

Yes, very much, and I really didn't miss anything at the time. While I had little time left for my family while working at the hospital, and I did lots and lots of graveyard shifts, I still would never have thought about leaving hospital work, initially. It was not until I got into my studies, and had the experiences at the trauma center that I started thinking that there's got to be something else yet. I would like to take a look behind the scenes of the hospital system.

In industry, you then made quite a few stops, from Grünenthal to Johnson & Johnson to Grifols – what made you say: It's time for Roche now?

 I like new challenges, and I found Roche's product portfolio impressive and innovative. In addition, I think the company has the right therapeutic approaches. We in Market Access are part of making these approaches accessible for patients, and that's what I wanted to be part of.

As for the product portfolio: Is Roche a company focusing purely on oncology?

No, our research is very diverse. It includes, e.g., hemophilia– we are currently also applying for approval of a product for multiple-sclerosis patients. We are active in dermatology, ophthalmology, as well as Alzheimer's research, and we are also working on other neurological diseases.

What departments does Market Access actually have?

 As mentioned, we have our own department for our pipeline, a Pricing department that deals with questions such as these: What is an adequate market price? What is our competition doing? In addition, we have a department that is responsible for benefit assessments, which we have to submit to show the added benefit and to prove the advantage over existing therapeutic methods.  And then there is the Stakeholder Management department, which takes care of our relationships with stakeholders. They include experts in medical research, but also in health policy. How can we design our healthcare provision to be more ideal?  How can health insurers, policy makers and the industry best cooperate?

Would it also be correct to say that your department is a link between researchers and policy makers?

The way I would rather express it is that we translate the conditions imposed by the healthcare system into the language of clinical developers, thus playing a part in the direction the design of studies takes. This is very important, for an active ingredient can be as great as all get out – if the study is set up the wrong way, we will ultimately not be able to bring the medication to market. Basically, we try to have the criteria of the healthcare system permeate all of the classical processes of clinical research in order to make sure that the process is successful. Here, we have to balance many questions and perspectives: What does the market want? What do the professional associations want? What do policy makers want? What are the current market trends? What do public health guidelines say?

Do you have a success story for us?

I'll just tell you what happened today. We recently had a product that was being evaluated by the Joint Federal Committee. Of course, we tried to meet all of the criteria for the product, and yet, the Committee was not totally convinced. However, as we absolutely wanted to get this product approved, we submitted additional data, in close coordination with the Joint Federal Committee – and succeeded. We received word today that we will get the additional benefit. This shows how the systems can cooperate successfully. This is really about the patients, and here at the company, we are keeping our fingers crossed for such decisions.

This story definitely does not match the media image of the "bad pharmaceutical corporations."

No, and this generalized image is also wrong. When we see a molecule in our R&D areas that can heal a disease – may it be ever that rare – we will definitely strive not to drop this product only because it might only help very few patients.  To be able to do this, we have such a large pipeline that we will probably be able to absorb the costs and make these investments in order to help the patients. I think this is a convincing company philosophy.

Your area deals with reimbursement processes, economics, the healthcare system and politics. What kind of employees are you looking for?

 A person must be able to think along with different, complex structures, and empathize with other ways of thinking. What we are also looking for are people who have a spine. If you are speaking with the head of a health insurer or a politician, you have to be able to represent the company and your own point of view. We often work on a team here, but there are always situations in which we are travelling as lone wolves. Roche is a so-called matrix organization; i.e., it is not a typically hierarchically structured company with rigid areas of responsibility. Individuals have a lot of freedoms and their own areas of responsibility, which they should also be willing to stand behind self-confidently.

What other skills do applicants need?

 We are looking for physicians, ideally with clinical experience. Experience in Market Access is not important, for we can teach this to new hires. We find it important that applicants have personality, for we are looking for edgy, non-conformist people. People with so-called soft skills – who are creative and innovative, and who are willing to take new paths, and to fight for something. If I were in the movie industry, I would now say I need a character actor.

Have you ever regretted your decision switch to industry?

This is a question that I am also asked by many of my former colleagues. I have been working in industry for a rather long period of time, and I can speak with conviction now: The industry is extremely exciting, and there are so many more opportunities for development than in classical clinical operations. It is especially after your residency, when the learning effect at some point approaches zero, that a certain routine starts creeping into your workday. I have never reached this point in industry.

Isabel Henkel is Head of Market Access at Roche Pharma AG in Grenzach-Wyhlen. Before that, she held positions such as Director of International Market Access at Grifols and as Director of Market Access and Reimbursement at Johnson & Johnson. She received her medical degree from the Free University of Berlin.

Roche Pharma AG Trainee Program: Management Start Up Market Access

Roche Pharma AG is looking for graduates for the "Management Start Up (MSU) Program Market Access" trainee program who have completed their Master's studies in medicine, business management, natural sciences, or pharmaceutical science with very good results. In this 24-month trainee program, the trainees will rotate through various work areas at Roche Pharma AG. They include Strategic Pricing & Reimbursement, Payer Strategy, Pipeline Product Strategy, and HTA & Value Strategy. For the duration of the "Management Start Up Program Market Access,“ the participants will be supported by an experienced leader as their mentor. In addition, a variety of continuing education offerings from Learning & Organizational Development will serve as subject-area and personal continuing education for the trainees. This cross-division and cross-site training will prepare the trainees for a future leadership position at Roche Pharma AG. Additional entry options at Roche and current job postings can be found at Roche.com/de/careers

© This article appeared in the 2/2016 issue of the arzt & karriere magazine. arzt & karriere is published by Evoluzione Media AG.

Tags: Career Blog, Germany