Pavel Kolev, AbbVie Bulgaria: Healthcare Systems Worldwide Are in for 10 Really Challenging Years Ahead

There are three major challenges for the pharma industry in Bulgaria, says Pavel Kolev, Country Manager of AbbVie Bulgaria since June of 2022. Before taking up this role, he has held various executive positions at the strategic marketing function of the company, both in Bulgaria and abroad. He was in charge of the area marketing for Gastroenterology, and later moved on to global marketing. When named General Manager of AbbVie Bulgaria, he was Immunology Business Unit Director in Russia. Before joining AbbVie, Pavel Kolev had held different positions at AstraZeneca Bulgaria. He has a Master of Science degree in Pharmacy from the Medical University of Sofia.

Mr. Kolev, AbbVie is a rather young company with a 10-year presence in the pharma market only. How likely do you think it is to successfully apply in Bulgaria one of the parent company’s core principles, i.e. to take on the toughest health challenges?

AbbVie may have a humble 10-year history as a separate company, but we are proud that, since the spin-off in 2013, we have managed to fuse the traditions, knowledge and experience of a company that has been on the global pharmaceutical market for over 100 years, with the enthusiasm, the future-oriented mindset, and, if you will, the naivety that are characteristic of entrepreneurship, of new beginnings. I have had the pleasure to join this journey from the very start and witness first-hand how, in just ten years, a new pharmaceutical company has formed, developed and grown to become US No. 1 and worldwide No. 2 by revenue in 2022.

AbbVie’s advent was indeed coupled with the ambitious goal to address unmet problems and solve the challenges to patients and healthcare systems, or to be a driving force in enhancing patient care and improving their quality of life. We are proud that in those 10 years we have managed to bring about a revolution in the treatment of hepatitis C and we may now speak of curing it; to launch 2 new alternatives in the field of Immunology, where we have always had a solid presence and boast traditions & knowledge; to provide a new mechanism of action for physicians and patients with chronic lymphocytic leukemia and acute myeloid leukemia in Oncohematology, as well as to give the patients with severe Parkinson’s disease a chance to lead a decent life. Our ambition does not end here and AbbVie is developing many other molecules in an even greater number of therapeutic areas. As for Bulgaria, I would say that we manage, to a large extent, to bring those therapeutic options to Bulgarian patients and physicians as well. This is not an easy process and involves a number of bottlenecks, but I am optimistic that if everyone involved in that process puts patients at the center, we will be able to come up with solutions.   

What appear to be the greatest challenges to the domestic pharma industry and is there a formula for overcoming them more quickly?

We are all aware that a perfect system does not exist and there is always room for improvement. I find the following to be the greatest challenges to the industry:

  • Lack of predictability;
  • Complicated patient journey;
  • Unclear collaboration and dialogue framework.

The lack of predictability is largely due to the fact that 2019 saw the introduction in Bulgaria of a Mechanism ensuring predictability and sustainability of the NHIF’s budget, which, as the name suggests, aims at protecting and making predictable the costs that the state “incurs” for medicines. That Mechanism, however, provides no such predictability to pharmaceutical manufacturers, as it relates directly to the NHIF’s budget, with the latter being a pretty unclear concept in terms of amounts and timeframes, especially against the backdrop of a political crisis. To put it otherwise, the Mechanism, as currently existing, mandates that where the NHIF has no budget or the budget proves insufficient to cover the costs actually incurred for medicines in the previous year, the pharmaceutical companies find themselves obliged to refund to the NHIF amounts that exceed their sales growth over the current year, that is to say, they would operate at a loss. There is little economic logic in this approach, and what is more, it renders unpredictable the future and the investments made by the industry in Bulgaria.

At the same time, to gain access to the so called “expensive” medicines, Bulgarian patients have to face a quite cumbersome, time-consuming and complicated system of prescribing, approval, and regular re-approvals. Owing to that bureaucratic system, it would take months for an immunology patient to gain access to the needed treatment. As a company, we are pioneers and experts in the so called “patient support programs” that help navigate patients through this system. That situation, alongside the economic unpredictability of the pharmaceutical industry in Bulgaria, means that thousands of patients would be at risk of never accessing their therapies, if it were not for these programs.

Lastly, as far as the collaboration and dialogue framework or platform, if you will, is concerned – well, it is practically non-existent. I sincerely hope that with the new management and figures at the Ministry of Health and the National Health Insurance Fund, as well as with all other healthcare stakeholders, we will find the manner, form and type of communication to enable all parties to participate in a process of outlining the vision of development for the coming years, thus identifying both the priorities and the most immediate actions that would bring about enhancement of the healthcare system in Bulgaria.

You have been recently elected member of the Management Board of the Association of Research-based Pharmaceutical Manufacturers in Bulgaria (ARPharM) and that came only a year after you had headed AbbVie Bulgaria. What do you think this appointment signifies and how do you see your role in the organization’s management?

– ARPharM enjoys recognition and is well established in Bulgaria. I take pride in the fact that, having served as a General Manager for 1 year at AbbVie, I was given the opportunity and was elected from among the member companies to sit on the Management Board of the Association. I believe that together with the other members of the Board who are also representatives of the research-based pharmaceutical companies in Bulgaria, we will find a way to work jointly towards addressing and solving the aforementioned issues that face the industry, and we will succeed in making the environment more predictable and more transparent to companies. Moreover, and most importantly, we will help Bulgarian patients gain access to innovative therapies whenever they need them.

What I see as the Association’s 3 major priorities in the coming 2-year period are:

  • Reputation;
  • New perspective;
  • Initiative.

Reputation of the innovative pharmaceutical industry – it’s high time we clearly reminded society that the pharmaceutical business develops and finds solutions to unaddressed therapeutic concerns, thus saving lives.

New perspective – we develop innovative medicines, we are the Association of innovative companies, and now is the time to be innovative in the solutions we put forward to politicians, patients and society in general. The National Health Strategy 2030 purports the introduction of a number of changes and the Association needs to take an active stance in devising that strategy together with all authorities, professional organizations and partners.

Initiative – we have to be ever more active and ever more significant a factor in proposing solutions to the healthcare system. We have the latest pharmaceutical technologies and know-how, we know what needs to change, and we are able to contribute to the solving of so-far unmet healthcare needs.

The company is largely focused on developing innovative medicines. What is your idea of sustainable growth in the next decade based on that concept?

Healthcare systems worldwide are in for 10 really challenging years ahead. A demographic crisis, inflation, political insecurity, new technology (including AI), and digitalization are just a few of the challenges and opportunities facing healthcare and the pharmaceutical industry as an important factor in that complex system. In my opinion, the pharma business in general will have a key role to play in the evolution and advancement of healthcare. And this is not only in terms of developing new therapies and solutions, but also in joining forces with the other stakeholders to forge sustainable healthcare that puts patients at the center and safeguards access to modern, timely and efficient healthcare to anyone in need. But for this to happen, we need dialogue, long-term vision and a formulated strategy.

I want to believe that in Bulgaria we will succeed in finding the right platform and manner for the dialogue and properly aligned strategy to come to the fore and be carried out.

For me, the first and most crucial step in that direction is to shift the way healthcare is perceived so that instead of “costs”, it is seen as “investments”. It is only by embracing this perception, that we can take a long-term view and adjust the approach from one focused on “economizing” to one engaged in “strategizing”.