- 2 years ago
19 August 2024
“You have to go for the heart,” Prashant Nikam, MSD’s outgoing managing director of Australia and New Zealand says about his role in transforming the affiliate from a primary care business with a large geographical footprint into a much smaller organisation focused on speciality care products.
“You have to get people to believe that what they do every day matters, that they come here every morning because they are impacting somebody’s life.”
Nikam’s focus on purpose and on patients was clear both when he sat down with MedNews for his first interview after arriving in Australia in 2022, and for his last as he prepares to leave this week to lead MSD Japan’s oncology portfolio in a market six times larger than Australia.
He leaves Australia’s shores having accomplished much, not just in ensuring his successor takes on a much smaller, engaged team, but in challenging Australia’s health technology assessment (HTA) system to think differently about innovation, access and value.
Nikam’s leadership in many ways encapsulates the perfect blend of heart and head, which is perhaps unusual for a health economist. He coined the phrase #PatientsCan’tWait shortly after arriving for what was his first job away from the head office yet it was quickly apparent leading is something Nikam was born to do.
“You get a lot of empowerment and trust in a role like this where the senior leadership say, do what’s right for the company, for patients and our customers,” explains Nikam. “If you apply that principle, this role becomes a white paper that you can paint whichever way you want.
“You can change culture, you can build structures, you can transform ways of working. I have genuinely loved having the freedom to do things differently, creatively, and to experiment and find out what worked for me, and what didn’t.”
One thing that did work for Nikam was spending time in the office kitchen. He says it kept him in touch with people and gave him first-hand insights into everyday life at the company – and to keep the home fires burning.
“I love the kitchen,” he exclaims. “You see everybody, you talk to everyone – I love that!”
A journey of self-discovery
Australia has in many ways been a journey of self discovery for Nikam who was born in northern India and moved to America in his early 20s before starting his pharma career. He loves the smell of eucalypts and gardenias that surround his Sydney home while at work, he has come to realise perfection is often not an option, and he needed to decide whether he would settle with 80 per cent, or just 60 per cent.
Yet he has much to be proud of, MSD noting 2.5 million people accessed one of its medicines or vaccines during Nikam’s time in Australia – an extraordinary feat, yet this leader still leaves with one regret in particular – his landmark venture to secure funding for the company’s blockbuster cancer therapy Keytruda across multiple cancer indications has not yet been achieved.
MSD proposed a single price be agreed upon with the government to fund all future indications for Keytruda once approved by the TGA, yet despite two PBAC submissions, Nikam will leave Australia with no agreement having been reached.
“We tried very hard as we sincerely believe we have a pragmatic proposal that can impact 20,000 people and are not satisfied that people have to wait over 440 days between after TGA registration for funding because cancer patients, especially, don’t have time,” he says. “They can’t wait, yet the government is lacking any sense of urgency.
“I feel every time you do something innovative, you have to take some risk, embrace uncertainty and say, I’m not going to cross every t and dot every i but my social contract is to the people, and cancer is the biggest problem we need to solve.
“To me, that lack of urgency is unfortunately where I feel part of my job is unfinished. We should have crossed the line. The Australian Government knows exactly how we are thinking, and I genuinely feel they are missing the point that they can invest and derive significant value here.”
It is in matters like this where Nikam’s unique blend of caring and pragmatism, of heart and head, are most evident – his heart wanting to deliver a life saving and life extending medicine to patients with genuine need; his head wanting to bridge the seemingly unfathomable gap between the government’s willingness to pay and the company’s need to derive appropriate value for its innovation.
“Uncertainty is real and but not insurmountable, because that’s where negotiation happens,” he says pragmatically. “But we can’t be making proposal after proposal – the government has to come to us and say, this is what we are willing to pay. Belgium, Greece and the Nordics all have multi cancer deals because those governments said, we don’t want to keep reviewing Keytruda again and again, we acknowledge it has value.
“Once you get over that ‘willingness to pay’ hub, you can say, I’m going to embrace uncertainty by negotiating with you, and this is how I’m going to price these indications. That’s perfectly fine. We are happy to talk about it.”
From one challenge to the next
Despite such frustrations, Nikam says dealing with theAustralian and New Zealand governments has been one of the most rewarding aspects of the job.
“I’ve loved the external engagements and learning how the political systems in both countries work. I’ve tried to simplify things because at the end of the day, when we go to Canberra or to Wellington, we need to clearly articulate what it is we want to accomplish and the pragmatic solutions we are proposing.
“It is classic negotiation and we need to think about getting a win:win – for the government, for patients, and for us by defining a common goal and genuinely and sincerely being a thought partner that transparently says, this is what our goals are.
“Being in this role allows you to learn what’s important to each stakeholder then think, how can we get the best outcome for patients and the people we serve? Many sticky problems are solved through a transparent, simple approach, but both parties have to be there. If they are not, our work is to get them there.”
As Nikam starts his hand-over to the incoming MD (who is yet to be publicly announced), he is clearly excited about the next stage in his own career journey. He says Australia will always have a place in his heart, but he is also ready for a fresh challenge.
“Japan is a very interesting challenge for me as a leader, because I want to test my leadership in different cultures and different environments,” he explains.
“If you want to be a global leader, you need to operate in different cultural environments and markets of different scale. Japan is very big, but with scale comes complexity.”
It is a big step up for Nikam, but one this leader will undoubtedly tackle with the same blend of heart and head that has defined his leadership in Australia, and while he leaves big shoes for his successor to fill, he also leaves a company that at its heart knows its purpose, and that patients can’t wait.
©MedNews 2024