Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
WITH THE MINISTRIES OF HALAL LAW THRIVING MEDTECH WHEN LESS IS MORE
HEALTH AND INDUSTRY PAGE 14 MARKETPLACE PAGE 43
PAGE 12 & 13 PAGE 38
As well as the companies we have met for their support, assistance and enthusiasm.
2 ACKNOWLEDGEMENTS
5 PREFACE
6 FOREWORD
22 Great Expectations
27 Creeping Protectionism
29 Market Distortions
Making sense of the
Halal Law 30 Winning Stratagems
Feature
14 34 The Quest for Partners
Indonesia
Additional full-feature interviews from our Indonesia 2017 Report can be
accessed on PharmaBoardroom, the premier website for C-Level executives,
consultants and state actors in the pharmaceuticals and life sciences sector,
alongside hundreds of exclusive interviews featuring the main movers and
shakers of the industry, free country reports and sector insights supplemented
by the latest news from global markets.
@pharmaboardroom
Benoit Martineau of #Sanofi on helping
OMAR LUQMAAN HARRIS
implement the Indonesian government’s patient
General Manager Pharma, GSK
access roadmap
Indonesia
Read the interview
Preface
Indonesia is a country with a population of 260 million, contribut-
ing one third of ASEAN’s total GDP, boasts a burgeoning middle
class, and has a pharmaceutical and life sciences sector worth USD
5.5 billion with seven percent annual growth. When the rollout of an
ambitious universal healthcare plan, aiming to cover the entire pop-
ulation by 2019, is added into the equation, it is clear that Indonesia
cannot be ignored by the international investment community.
The country’s almost unlimited potential, however, remains large-
ly unfulfilled and numerous barriers stand in the way of Indonesia
taking its place at the top table of pharmaceuticals and life scienc-
es in Asia and the world. Indonesia’s vast and scattered geography,
the government’s tendency towards cost-containment, the fact that
70 percent of the market remains in the hands of local players, and
the country’s reputation for unpredictable and oblique regulatory
changes all pose challenges for existent players, new market entrants,
and investors alike.
Through in-depth interviews with government representatives,
CEOs of the leading MNCs implanted in the country, as well as the
leaders of Indonesia’s rich ecosystem of local companies, a picture
emerges of a pharmaceutical and life sciences market on the cusp of
realizing its massive potential, but with numerous hurdles still to
overcome.
I am proud to introduce the 2017 edition of the Indonesia Healthcare & Life
Sciences Review, which I consider an excellent opportunity to showcase the pro-
gress underway throughout the country.
Along with continued increase in the quality of life in Indonesia over the last
few decades, pharmaceutical and healthcare industries remain side by side as allies
in overcoming the challenges to bring high quality solutions and ensure the high
quality of health system.
Beginning in 2014, Indonesia has embarked on a transformative transition
towards achieving universal social health insurance coverage in 2019; to ensure
access, affordability and quality of health services across the country.
Within this very important national priority, the Government continues to col-
laborate inclusively with all stakeholders ranging from public, private, academia
and civil society groups.
Alongside this national undertaking is the rapid growth of Indonesia’s pharma-
ceutical market. Throughout the years, Indonesia continues to increase in prom-
inence, both globally and in the Asia Pacific region. As of today, the outlook of
Indonesia health system has prospered into a solid foundation of resilience and
ensured access to medicine for its entire population.
Through the Indonesia Healthcare & Life Sciences Review 2017, I invite all
members of the global pharmaceutical and healthcare communities to take a close
look at the promising opportunities Indonesia has to offer, and to consider how
they can leverage their unique expertise and capabilities to support Indonesia’s
path in national health development.
Sincerely,
LOCAL
CONVERSATIONS
GLOBAL
CONNECTIONS
www.pharmaboardroom.com
INDONESIA IN FIGURES
POPULATION: 258.3 MILLION (5TH IN WORLD) RELIGIONS: MUSLIM 87.2%, CHRISTIAN 9.9%,
HINDU 1.7%, OTHER 0.9% UNSPECIFIED 0.4%
CAPITAL: JAKARTA (10.3 MILLION)
GDP (PPP): USD 3.033 TRILLION
AREA: 1,904,569 SQ KM (15TH IN WORLD) GDP (PPP) PER CAPITA: USD 11,700
LIFE EXPECTANCY AT BIRTH: 72.7 YEARS
Source: : CIA World Factbook (2016)
13.9%
2030 296.4
171,939,254
18.6%
2035
305.6
+22.2%
(In million persons)
2016 Source: BPJS Kesehetan
INDONESIA 3.6%
2%
MALAYSIA 4.2%
PHILIPPINES 4.7% 1%
THAILAND 6.5%
0%
VIETNAM 7.1% 2010 2015 2020F
Source: WHO Data Series; Frost & Sullivan Analysis
PRESCRIPTION
4Q14 30% 32% 28% 9% 0.8% -6.8%
4Q15 31% 33% 26% 10% -3.2% -10.6%
4Q16 31% 35% 24% 10%
Source: QuintilesIMS
TOTAL MARKET
MOVING ANNUAL TOTAL (MAT) VALUES (Billions Indonesian Rupiees)
2.973
GROWTH(%)
4Q12 9.877 20.290 16.629
3.449
4Q13 10.958 22.628 18.862 12.31
3.739
4Q14 12.174 23.678 20.005 6.62
3.602
4Q15 14.179 24.620 20.127 4.92
3.809
4Q16 14.886 27.068 21.450
7.49
4Q 2016
MNC NON
MNC NON 5.7% PRESCRIPTION PRESCRIPTION
PRESCRIPTION 62.4%
11.0% DOMESTIC NON
28.9% PRESCRIPTION
DOMESTIC UNBRANDED DOMESTIC PRESCRIPTION
GENERIC BRANDED
CAGR 5 Y
IN % TOTAL MNC DOMESTIC
SELF-
RELIANCE AND
INNOVATION
Maura Linda Sitanggang, director general at the In- THE FIRST GOAL ENTAILS THE ACCESS
donesian Ministry of Health, describes the Ministry’s OF MEDICINES THAT WE WISH TO
roadmap for ensuring that all Indonesians have ac- GUARANTEE FOR ALL INDONESIANS.
cess to medicine and how the Indonesian pharma- IN THIS REGARD, THE UNIVERSAL
ceutical industry has developed its self-reliance and HEALTHCARE SYSTEM (JKN) HAS BEEN
innovativeness. AS EFFICIENT A PARTNER AS WE COULD
HCLS: How does the Ministry of Health organize
HAVE HOPED FOR.
its priorities and how far along have you come to-
wards reaching the initial goals since you assumed device industries and the development of their viability.
your position as director general last year? Indeed, local manufacturers still have very low capaci-
MAURA LINDA SITANGGANG (MLS): We have ty when it comes to active pharmaceutical ingredients
five priority goals within our responsibility. The first (APIs), as 95 percent of the APIs used in Indonesia are
goal entails the access of medicines that we wish to imported from countries such as China and India.
guarantee for all Indonesians. In this regard, the uni- We would like to encourage the national industry to
versal healthcare system (JKN) has been as efficient become more innovation-centered.
a partner as we could have hoped for. We work with
two powerful tools to ensure our success: the national HCLS: The Ministry of Health has designed a 15-
formulary for medicines – which already encompass- year roadmap to transform the Indonesian phar-
es more than 1,027 items and is continously updated ma industry into an innovative industry. Could
- and the electronic purchasing through e-catalogue you expand on the construction of this roadmap?
of medicines – which is under the supervision of the MLS: This plan consists of three stages of five years
Public Procurement Agency of Indonesia (LKPP) and respectively. We will focus on cooperation and trans-
allows the public healthcare facilities to avoid long ten- fer of technology in the first five years. The second
der processes as it includes most of the medical prod- five years will focus on acquiring and developing the
ucts needed while guaranteeing the compliance of the technology, and the last five years will be to witness
solutions listed. the local industries launch their own, locally manufac-
The second goal consists of the control of medicines, tured products by mastering their own innovative tech-
which has been mandated to the National Agency of nologies. Overall, we would like to see local companies
Food and Drug Control Indonesia (BPOM). invest higher percentages of their revenues into their
The third and the fourth goals are highly related, R&D divisions.
i.e. the improvement in quality of the pharmaceutical This ambitious goal really requires a collaborative
services and the responsible use of medicines. In these effort from the industry and the Ministry. However,
priorities, we have been setting the pharmaceutical ser- we are dedicated to support the industry as best as we
vice standard required in the healthcare facilities such can. In this sense, we have installed a bottom-up infor-
as national and international accreditations that are to mation flow to directly gain inputs from the industry,
be earned. while at the same time, the industry can easily have us
The fifth, and last goal, is centered on the securing take part in the challenges they meet and the successes
the viability of the pharmaceutical as well as medical they celebrate.
BUILDING DOMESTIC
MANUFACTURING
CAPABILITIES
Airlangga Hartarto, Minister of Industry of Indonesia, explains the Ministry’s
commitment to creating a business-friendly environment and mutually ben-
eficial collaboration between public and private stakeholders that are play-
ing a role in the implementation of Universal Healthcare Coverage (JKN).
S
ome industry leaders pharmaceutical industry to com- sciences sector as pharmaceutical
have argued that the ply with new regulations as soon companies could stop producing
‘Halal Law’ will simply as possible. Minister of Industry drugs in Indonesia or even refrain
be unworkable in prac- Airlangga Hartarto affirms that from bringing them to market for
tice. Darodjatun Sanusi, “pharmaceutical companies have fear of sanction for non-compli-
executive director at GP Farmasi to quickly adapt their offering and ance.” These potential sanctions are
(National Association of Local procedures to local regulatory spec- strict, with failure to maintain the
Companies in Indonesia), postu- ifications such as the Halal Law, halal status of a product that has
lates that “any form of mandatory which might soon be applicable for obtained a Halal Certificate being
implementation of halal certifica- pharmaceutical products.” punishable by imprisonment of up
tion, as it is projected now, will be This legislation stands as a to five years or a fine of up to Rp
close to impossible as 95 percent direct threat to the operations of two billion (USD 150,000).
of our raw pharmaceutical ingre- pharmaceutical MNCs with oper- Local pharmaceutical outfits
dients are imported; coming from ations in Indonesia as well as to also stand to be negatively impact-
different sources and making it Indonesian patients’ ability to ed by this controversial law; with
pretty difficult for the government access innovative and potentially state-owned vaccine producer Bio
to audit the producers on the halal life-saving treatments. In the words Farma calculating that the nation’s
status of their products.” of Parulian Simanjuntak, executive vaccine industry faces up to Rp 1.5
However, the Indonesian gov- director of IPMG (International trillion (USD 156 million) in losses
ernment seems to be steadfast in Pharmaceutical Manufacturers should the bill be passed into law
its determination to deploy the Group), “[the Halal Law] could in its current form. Additionally,
Law and has been encouraging the pose a real menace to the life as A. Lin Neumann, managing
director of the American Chamber into Indonesia. Minister Hartarto There is also the potential that
of Commerce in Indonesia, high- avows that “We are fully aware that the Halal Law will create oppor-
lights, “The Halal Law would mean in order to create a strong domes- tunities, especially for companies
that [pharmaceutical] companies tic industry we need to attract both with manufacturing in Indonesia.
are required to separate their man- foreign and national direct invest- Some industry players are starting
ufacturing and supply chain from ments to Indonesia. Thus, we are to consider the potential of posi-
other products.” actively working on creating the tioning Indonesia, the country
In terms of the Law’s impact on regulatory environment that will with the world’s largest Muslim
investment into Indonesia, some certainly bring those investments.” population, as a Halal manufactur-
believe that the damage has already How regulatory certainty for ing hub to serve not only nation-
been done. The impression that pharmaceutical companies can al demand but also other mar-
Indonesia remains a high-risk coun- be squared with the Halal Law kets with predominantly Muslim
try to do business where the regu- remains unclear, but state-industry populations such as the Middle
lation can change practically over- dialogue is ongoing to find a solu- East. Dede Yusuf, chairman of
night has been compounded by the tion. IPMG’s Simanjuntak posits Commission IX of the House of
Halal Law, especially as the legisla- that “there are two solutions that Representatives responsible for
tion’s implementation regulation should be discussed: amend the law the Health and Manpower sectors,
for the pharmaceutical industry has in order to take out pharmaceuti- states that “we would be delight-
not yet been issued; creating a lot of cal drugs from the Halal context, or ed if companies could make Halal
question marks and uncertainty. make voluntary the application of medicines and they would even be
However, the Indonesian state such law within the manufacturing able to sell them to other Muslim
remains eager to attract investment process of pharmaceuticals.” countries.”
EFFICIENCY AND
TRANSPARENCY
THROUGH
TECHNOLOGY
Dr. Agus Prabowo, chairman at LKPP (National Pub-
lic Procurement Agency) explains the importance of
embracing technology to gain efficiency and effective-
ness in the public procurement process for healthcare
products and highlights the outcomes of the imple-
mentation of an e-catalog in Indonesia. AGUS
PRABOWO
HCLS: Could you please introduce are the main
chairman, LKPP
activities of the LKPP?
AGUS PRABOWO (AP): LKPP is the National
Public Procurement Agency and is a governmental insti-
tution that was established back in 2008. LKPP’s main
mandate is to reform the current procurement model,
which represents a significant percentage within the pendence of Indonesia on medicines and medical de-
total state budget, towards a more efficient, transparent, vices imports.
and reliable procurement system. My main priority in healthcare is to empower the use
In this sense, we have four strategic underpinnings of better systems such as e-catalog to serve all public
to support our mission: regulatory, education, IT, and hospitals or public care centers in their routine health-
integrity. We create detailed and solid procurement reg- care expenditures. I want to highlight that e-catalog is
ulation to avoid any misunderstanding, we educate all going to play an important role in the implementation
government officials to successfully implement our pro- process of universal healthcare coverage (JKN) that the
curement programs, we empower the use of technology current government is putting in place in Indonesia;
in our activities, and we ensure that all the three afore- LKPP is highly aligned with the government’s goals.
mentioned guidelines are aligned towards a more effi-
cient, transparent and reliable procurement system. HCLS: How engaged is LKPP in the successful im-
plementation of JKN?
HCLS: LKPP is in charge of formulating, devel- AP: We act as mediators between the producers and
oping and implementing public procurement poli- users, which are industry and government respective-
cies for several industries. Could you expand on the ly. Indeed, we put both stakeholders together to define
main priorities on your agenda that are related to the specifications of the medicines or medical devices
the healthcare industry? as well as the price to subsequently list such products
AP: LKPP oversees several industries, but healthcare in an open market, in this case e-catalog, that will pos-
plays an important role in our operations and we are itively impact all the actors within the healthcare sec-
creating a more open market through several initiatives tor. We have disrupted the way procurement is done in
such as “e-catalog”, which is an e-market place for med- Indonesia through implementing technology in order
icines and medical devices. This is even more complex to minimize inefficiencies within the tendering system
to manage than other sectors because of the high de- such as transparency and lead times.
is still below the actuarial that dictates the real cost of strong commitment of the government in providing, at
the healthcare service – which the government used as least, basic healthcare to the entire population.
a benchmark but did not fully implement in order to
enlarge healthcare access. Therefore, the financial deficit HCLS: What is the solution to this financial mis-
of JKN-KIS will continue to exist even if all Indonesians match?
pay the premium established according to their segment. FI: There are three different solutions that were as-
The JKN-KIS premium and the actuarial obviously vary sessed to drive JKN-KIS towards financial sustainability:
according to the social economic segment. In order to increasing premiums; reducing the pack of healthcare
ensure a better understanding of the current financial sit- services, and capital injection.
uation, let me expand on the economic numbers – premi- The first consideration was to increase the premiums
um versus actuarial - of two segments: the poor and the paid by society in order to minimize the economic gap
self-employed. between the premium and the actuarial. Nevertheless, this
Firstly, the established monthly premium for poor and measure will directly reduce access to healthcare services
near poor segment is Rp. 23,000 (USD 1.7) per capita versus since the financial capacity of a large part of the population
the actuarial calculation that is Rp. 36,000 (USD 2.7) - there cannot afford any increase in premiums. Consequently, this
is a gap of Rp. 13,000 (around USD 1). measure is not aligned with the constitutional objective of
Secondly, the established monthly premium for the covering all Indonesian citizens.
self-employed segment is sorted out into three different The second option would be to reduce the pack of health
healthcare service levels. In the third class, the established benefits covered by JKN-KIS in order to decrease the actu-
monthly premium is Rp. 25,500 (USD 1.9) per capita ver- arial cost. However, the current system is only covering
sus the actuarial calculation that is Rp. 53,000 (USD 3.9) basic care services, which are highly needed by the popula-
- there is a gap of Rp. 27.500 (around USD 2.00). In the sec- tion. Again, this way would not be ethically viable and not
ond class the established monthly premium is Rp. 51,000 aligned with our constitutional objective of covering basic
(USD 3.8) per capita versus the actuarial calculation that is healthcare needs.
Rp. 63,000 (USD 4.7) - there is a gap of Rp. 12,000 (around Thirdly, the government could inject more money into
USD 0.9). In the first class, it is the only segment where we JKN-KIS in order to finance its implementation, regardless
do not have any gap since actuarial exactly matches with the of the deficit. This is currently the chosen option by the
premium established. government and clearly shows the strong commitment of
The reason why the program continues, no matter the President Joko Widodo to deploying universal healthcare
fact that it is systematically designed to be in deficit, is the coverage in Indonesia.
INDONESIA
The Awakening Giant?
Not so long ago dismissed by international investors as
Asia’s “great underachiever”, Indonesia, complete with its
sprawling population of 260 million and blossoming middle
class, tends to elicit great enthusiasm and fanfare these
days. Nowhere is this truer than in the pharmaceuticals and
life sciences sectors. Valued at USD 5.5 billion, and regis-
tering an impressive seven percent annual growth, the local
pharma market stands out as being one of the best perform-
ing in the entire region.
Other actors, however, are proceeding rather more state expenditure on public health.
cautiously. “While it is true that an increase in dispos- “Prior to implementation, annual
able incomes has resulted in a surge of sales for beauty health insurance for the poor ran
and personal care products and in spite of there being to the tune of some IDR eight tril-
much clamour and hubbub about Indonesia breaking lion (USD 602 million). Nowadays
into the top ten global skincare markets by 2019, we this budget for the poor and nearly
still perceive complexities in the day-to-day dynamics poor, known as the ‘Contribution
of the local marketplace,” contemplates Holger Welters, Assistance Recipient,’ has shot up to DR. NILA
president director of the skincare specialist Beiersdorf, approximately IDR 25 trillion (USD MOELOEK
another prolific investor in the Indonesian life sciences 1.8 billion) and, in the parliament, minister of health
space. “It is clear to me that while the underlying poten- we are pushing hard for an even
tial certainly exists, this potential has not yet been con- greater allocation,” affirms Dede
verted into a reality,” he warns. “Thus, we have to be Yusuf, chairman of Commission IX,
highly selective when approaching this kind of oppor- the health and manpower commis-
tunity, keep our feet on the ground and set about eval- sion of the Indonesian parliament.
uating these forecasts carefully and pragmatically.” These developments, logically,
represent quite a game changer for
a pharmaceutical industry long
critical of anemic public spending
MAURA LINDA
GREAT EXPECTATIONS on healthcare. “Our clients have SITANGGANG
been much encouraged by the sheer director general of
Perhaps the single issue that has served to whip up opportunities generated by JKN: the pharmaceuticals and
medical devices,
investor confidence more than anything else has been market has overnight become con- ministry of health
the Joko Widodo administration’s ambitious reform siderably more attractive for them
of the country’s national health service. Indonesian and we are witnessing a surge in
healthcare has traditionally been notorious for its frag- investments, acquisitions and joint
mentation. However, in the fall of 2014, Indonesia’s ventures, all of which affords local
government surprised many by launching a radical ini- companies the prospect to acquire
tiative to establish a compulsory national health insur- technology and know-how hitherto
ance system with the aim of providing basic care for all out of reach. Taking all of this into
by 2019. Nila Moloek, Minister of Health, reaffirms “The account, our calculations now place
Indonesian government is committed to achieving its Indonesia’s pharma sector as grow-
PENNY LUKITO
goals in the health sector […] among other things, the ing at a rate of around seven percent
head, BPOM
JKN program, which has drawn in more than 175 mil- annually over the next four to five
lion people.” years,” recounts Wiwy Sasongko,
The scheme, known as ‘Jaminan Kesehatan Nasional’ managing director of QuintilesIMS.
or ‘JKN,’ primarily seeks to improve the livelihoods of Other commentators have been
citizens stuck in the middle – namely those too poor to quick to concur. “I know of one
afford health insurance, but deemed not poor enough medical device company whose
for state support. Under the provisions of JKN, all cit- products are registered on the gov-
izens would now be able to access a tranche of basic ernment’s reimbursement list that
health services provided by public facilities, and certain has registered a leap in their reve-
specially designated private ones too, covering treatment nues of 50 percent in the last year
AGUS
for everyday illnesses from chest infections to surgery alone,” confides AmCham manag- PRABOWO
and chronic diseases. ing director, Lin Neumann. “There chairman, National
Rolling out a grandiose welfare program on this scale is no doubt that this reform heralds Public Procurement
Agency (LKPP)
has logically gone hand in hand with considerably higher a very positive step for the industry
as a whole” agrees Chris Wren, executive director of the developing an integral solution that enables a treat-
British Chamber of Commerce, “multinationals right ment continuum between patients and doctors, and
now enjoy the largest share of the therapies being reim- JKN provides a proper opening for us to finally bring
bursed under the system and they are seeing the public that to market,” enthuses Suryo Suwignjo, president
sector outpace the private in terms of growth rate, which director of Philips.
is tremendous news when you consider Indonesia’s Siemens Healthineers’ country lead, Steven Lee, is
mammoth untapped market.” equally forthright. “This decisive boost to the purchas-
ing power of the public hospital apparatus marks a
golden opportunity for Siemens to deliver up new inno-
SEEING THE PUBLIC SECTOR OUTPACE vations and methodologies and to simultaneously fur-
THE PRIVATE IN TERMS OF GROWTH nish both private and public arenas with state of the art
RATE, WHICH IS TREMENDOUS NEWS solutions that can radically improve the patient expe-
WHEN YOU CONSIDER INDONESIA’S rience. It also fosters the right receiving environment
MAMMOTH UNTAPPED MARKET. for us to be able to extend beyond an essentially prod-
CHRIS WREN BRITISH CHAMBER OF COMMERCE uct-oriented approach towards a more holistic offer-
ing in which we can act as a true healthcare solutions
Medical device companies and healthcare solutions provider rather than merely a piece-by-piece equipment
technology integrators are especially enthusiastic about seller” he observes.
the additional spending power that the reform confers
upon hospitals. “The implementation of universal
healthcare coverage is, without a doubt, driving hospi-
tal demand for more efficient equipment and for more PLUNGING INTO THE RED
effective integrated care solutions, which represents
precisely the sort of space where we believe we have the Materializing JKN’s lofty ambitions, however, is prov-
most to offer… our overall healthcare strategy is about ing to be a formidable task for a national treasury
already under increasing strain. “As What, then, is the solution to resolving this systemic
of today, JKN covers some 178.2 mil- financial mismatch? Three solutions have been mooted:
lion citizens which is roughly equiv- increased premiums, reducing the pack of healthcare ser-
alent to 70 percent of the national vices, or external capital injections. Increasing the premi-
population, but there remain big ums paid by society in order to minimize the econom-
question marks over how to render ic gap between the premium and the actuarial would,
the system financially sustainable however, compromise the principle of universal coverage
PARULIAN in 2019 when it is supposed to be because a large segment of the population simply can-
SIMANJUNTAK catering for 260 million,” admits not afford any increase. Similarly any reduction in the
executive director, Fachmi Idris, president director healthcare package would also leave patients untreated
IPMG
of Badan Penyelenggara Jaminan as the current system is presently only geared towards
Sosial Kesehatan (BPJS), the social covering basic care services, urgently required by the pop-
security agency charged with imple- ulation. So far, therefore, the Widodo administration,
mentation, “we are fully aware that ever attentive to courting popular opinion, has resort-
we will need to do much better in ed to option three: injecting whatever cash is needed to
attracting and registering the non- breach the gap, in the full knowledge that this cannot be
poor segment if we are to properly sustainable in the long run when coverage is mandated
balance the books and render the to expand yet further.
DARODJATUN program financially stable.” For Sigit Priohutomo, chairman of the National
SANUSI Indeed, at present, JKN is run- Social Security Council or ‘DJSN,’ the only feasible way
executive director, GP ning at a chronic deficit with state to square the circle will be to “establish a co-payment
Farmasi
coffers making up the shortfall.
Idris explains how this comes
about. “The established month-
ly premium for the poor and near
poor segment is Rp. 23,000 (USD
1.7) per capita versus the actual cost
that is about Rp. 36,000 (USD 2.7)
leaving the equivalent of a 1 dollar
gap to make up. Then for much of
DR. KUNTJORO
ADI PURJANTO the self-employed there is also an
chairman, PERSI overspend compared to the premi-
ums: tier two citizens, by socio-eco-
nomic profiling, have their month-
ly premiums set at Rp. 51,000 (USD
3.8) against the actuarial calcula-
tion that is Rp. 63,000 (USD 4.7)
meaning that it is really only the
tier one segment that pays a premi-
um that matches the real cost. The
brute reality is that financial deficit
DEDE YUSUF
would therefore continue to exist
chairman,
Commission IX
even under perfect conditions in
which each and every citizen pays
the premium established according
to his or her segment, all because of inherent flaws in
the structural design!” he laments.
#1 KALBE FARMA
#2 SANBE # 9 SOHO
10 NOVELL PHARM
#3
#
DEXA MEDICA
PHAROS 11 BIOFARMA
#4 INDONESIA
#
Source: QuintilesIMS
novel mobile healthcare application promoted by the medical devices at the Ministry
Mensa Group, are also being trialed as cost savings meas- of Health. “We see our mission
ures. “Halodoc’s purpose is to drive healthcare demand as providing support to an infant
towards different cheaper channels, so that rather than industry in its transition from a
visiting a doctor for a simple headache, a short telecon- trading to a research-based logic
sultation might instead suffice,” says Jonathan Sudharta, by the horizon of 2025, by which
member of the Board of Directors at Mensa Group. time it should be able to stand
In view of the scheme’s unsteady economic outlook, firmly on its own two feet,” she STEVEN LEE
some of the more wary pharmaceutical actors have been elaborates. country lead,
Siemens Healthineers
adopting a ‘wait-and-see’ posture. “To date we, have been “We are collaborating closely
hesitant to create any significant dependency on JKN with the government to increase
until we can gain greater clarity on pricing rules and the power of indigenous phar-
timeframes for payment,” confides Servier’s Alban Nérot. maceutical firms and have set a
“Although JKN could potentially represent a decent mid- target of increasing the exports
term opportunity for us, it could equally instead adverse- of local players to 30 percent of
ly impact the P&L of multinational innovative drug production capacity. Meanwhile
developers, by favoring locally sourced generics…and we are pulling out all the stops
with the ongoing uncertainty surrounding its financial to promote Indonesian self-suf-
SURYO
viability we prefer to exercise prudence and stick with the ficiency of raw materials such as SUWIGNJO
tried and tested private market for the time being.” active pharmaceutical ingredi-
president director,
ents,” attests Darodjatun Sanusi, Philips
CREEPING PROTECTIONISM
Thailand, Mexico and Egypt, among of intent,” reassures idsMED’s pres- the South East
other places—and just barely ahead ident (core market) and senior man- Asian theatre
of India and Tajikistan. Meanwhile, aging director for Indonesia, Rufi of operations.
the number of days containers spend Susanto. This is the type
between unloading and leaving the of market where
gates of Jakarta’s port, which han- more than 70
dles the bulk of Indonesia’s inter- percent of the
national trade, is currently at an all- WINNING STRATAGEMS pharmaceuti- ALBAN NÉROT
time high of six days. cal value is vest- managing director,
“ There’s no denying that What, then, are the secrets to mak- ed in the hands Servier
Indonesia has always been very chal- ing a success out of Indonesia’s of local players
lenging in terms of regulatory and high-risk, high-reward busi- and you have
structural issues; it has not wrong- ness environment? For Benoit to be quick on your toes… being
ly earned the reputation of being Martineau, president director of able to anticipating future dynam-
an unpredictable business environ- Sanofi, flexibility and adaptabil- ics in a fast-changing, fluid envi-
ment with certain lack of trans- ity are two useful assets. “Despite ronment and react rapidly is highly
parency, but those issues are now our positioning as the number one advantageous.”
gradually being resolved and the MNC in the country, I would say Being able to spot emerging
commitment to universal healthcare that Indonesia still represents one trends and being a first mover in
is certainly a very strong statement of the most challenging markets in aligning to them has certainly
proved lucrative for many actors. GSK, for its part, is betting
Mindful of Indonesia’s rapid eco- on adapting to a transforma-
nomic development, Siemens tion underway with Indonesia’s
has been astutely re-orientating epidemiological profile and the
its offering to cater to the needs explosive rise of chronic, life-
of a brand new middle class in style, developed-world style dis-
the ascendancy. “We have been eases. “While we recognise we
HOLGER increasingly pivoting towards are entering a period in which RUFI SUSANTO
WELTERS the middle and upper-middle the public market is going to president (core
president director, class private market,” expounds be the primary growth driver of market) and senior
Beiersdorf managing director,
Siemens Healthineers’ Steven Lee. the Indonesian industry, courte- IDS Medical Systems
“Our intention is to retain those sy of the rollout of JKN, we are
patients that are undergoing treatment abroad by forecasting that much of this
offering them higher standards in technology and growth projection is going to be accounted for by
innovation back home in Indonesian hospitals. The non-branded generics especially given the financial
industry as well as the government are endeavouring pressures afflicting the BPJS. Instead our attention
to reverse this patient outflow and we detect a real will be directed towards the non-communicable dis-
effort on the part of all parties to enhance standards ease segment – comprising cardiovascular, diabetes
of service quality so that is one specific niche that we and oncology - where our core competencies around
have selected to scope in on.” innovative medicine are known to be most effective,”
Dewi, the company’s country man- in the country. Having opened its
ager. “Firstly, Asians, in general, local affiliate less than five years
do not tend to complain so much ago the company registered 65
about pain, because in their cul- percent growth last year and now
tures it is perceived as impolite to boasts an in-country staff of over
be making a fuss. Secondly, opi- 100 employees. “It’s a long jour-
oid medicines are highly restrict- ney that needs to be supported
ed on the local market. Thirdly, by a lengthy repertoire of medical DJONNY HARTONO AGUS DARJONO
there has barely any education of education initiatives in collabora- president director, president director,
pain management in the medical tion with the medical associations, Enseval Metro Drug Indonesia
universities… We have therefore pharmacies and hospitals. The
made it our business to develop results so far are very encouraging,
this arena and spread understand- but there is still a long way to go,” “We ascertained exactly what the
ing about the dynamics of pain concludes Dewi. local market and local clients
and its alleviation,” she explains. Indeed one overriding hallmark required and remodeled our offer-
Right now, Mundipharma is con- of successful ventures in Indonesia ing to match accordingly. Doing
centrating its efforts on applying tends to be that they engage with business in this very young, raw
pain management knowledge in the marketplace on its own terms market is a world away from the
the treatment of cancer patients, instead of trying to transplant a much more static Malaysian eco-
one of the primary causes of death business model devised elsewhere. system or a highly developed and
h
to understand health.
en’s
Exeltis Indonesia
PT. Nufarindo
Kirana Two Office Tower
7th Floor Unit E
Jl. Boulevard Timur Kav 88
Kelapa Gading, Indonesia 14240
Phone: +62 21 2962 9755
M
de
o
rn
Plant Wo
Jl. Raya Mangkang Kulon, KM 16,5
u nd
Care
Kec. Tugu, Semarang, Indonesia 50155
www.exeltis.co.id
been taking a proactive stance to streamline these pro- “Yes, compared to other markets, innovative medi-
cesses through optimized cold chain management, a cine remains poorly represented on the national phar-
consolidation of our national distribution centers and maceutical agenda, so there is a massive amount still to
the integration of latest digital technologies,” confirms do, yet it is precisely because of this that Indonesia con-
APL’s president director Christian Eberle. stitutes a market where we can make a big difference
At the same time, APL has also been experiencing and where a company like ours, so long as it perseveres
a significant upswing in demand for its commercial- and conducts itself smartly, can reap real rewards,” he
ization and marketing services. “We deploy a unique concludes.
market insight and benchmarking tool, which gives cli-
ents strategic and tactical information to support their
decision-making. Through our insider understanding Kimia Pharma: Leading The Way
of the rapidly evolving regulatory environment and
our extensive business intelligence capabilities, we are Indonesia is the largest economy in the ASEAN region
uniquely positioned to execute an effective sales, brand with over five percent annual GDP growth in recent
years and is expected to break into the world’s top
development, channel management and marketing
ten economies by 2030. The Indonesian pharmaceuti-
strategy,” proclaims Eberle. cal industry, with a current value of USD 5.6 billion, is
expected to grow around seven percent annually and
more than double its size by 2020. This growth is led
by local players which make up nine of the country’s
top ten companies, account for more than 70 percent
THERE FOR THE TAKING
of the industry’s value and around 95 percent of its
volume.
What, then, to make of a market that seems to promise
so much, yet simultaneously poses such glaring draw- One significant driver of this growth is the rollout
backs? While it remains a complicated place for doing of Indonesia’s Universal Healthcare Program (JKN),
which aims to cover all of the country’s 250 million
business for the uninitiated, there can be no doubt that inhabitants by 2019. The government has adopted a
those companies that have cracked the market are gen- cost-driven approach when selecting which healthca-
erating good returns. re solutions to list in JKN; a move which has positively
Boehringer Ingelheim is perhaps a good illustration impacted domestic companies since they can offer
of this point. The company has been staunchly and more cost attractive solutions than their MNC peers,
which are more focused on innovative, and therefore
resolutely believing in the potential of the archipelago costly, drugs.
since the 1960s, even acquiring a manufacturing plant
in the early 2000s and continuing to invest heavily in One example of a local company benefiting from the
developing its local footprint. This perseverance has, government’s cost-conscious approach is Kimia Far-
indeed, been paying off and the company now finds ma, positioned as the industry top performer in 2016
and the leading Indonesian pharmaceutical SOE (Sta-
itself one of the fastest-growing players within the top te Owned Enterprise). Honesti Basyir, president di-
20 for the second year in succession. rector of the company, highlights that “JKN has been
“Indonesia remains a tricky market for MNCs one of our main growth drivers, representing 60 per-
because local players still dominate some 70 percent cent of our sales. Indeed, as the largest pharmaceuti-
of the pharmaceutical value and the pressures on the cal SOE we have the duty to support our government
in this journey. In terms of manufacturing, one of the
public purse are clear for all to see…Nevertheless, when main reasons we built our new manufacturing plant
you peer deeper into how the industry is organized, it in Bandung is to be able to cope with the growing
becomes clear that the local players are actually dom- demand coming from JKN.” To maintain this growth,
inating the OTC segment, whereas the prescription Basyir points to the fact that his company is “impro-
market is much more finely balanced with 45 percent of ving our operations; moving towards digitalization
both in back-end and front-end processes that not
the branded prescription medicines value in the hands only enhance product quality but also improve overall
of MNCs,” assesses Jorge Wagner president director of efficiency.”
Boehringer Ingelheim.
A PARTNER
FOR LIFE
Aylie Widjaja, managing director at Exeltis Indonesia,
shares her excitement about developing the compa-
ny’s footprint in Indonesia, making it a manufacturing
hub for Asia, highlights the challenges in navigating
the public market, and discusses the company’s sig-
nificant offering in the women’s health field.
G
out that “Indonesia by itself has more than 17,000
lobally speaking, the Indonesian islands with scarce healthcare infrastructure and pro-
medtech market is quite underdevel- fessionals; consequently, patient access is one of the
oped and highly reliant on imports. most important challenges to tackle. Therefore, tech-
Nevertheless, the market has expe- nologies such as digitalization and telehealth can cre-
rienced promising growth rates of ate important healthcare breakthroughs in Indonesia”.
approximately 15 percent on an annual basis dur- However, GE Healthcare’s Izmee notes that “even
ing the last decade and it is expected to reach USD 1 though the government is really interested in intro-
billion in value by 2020. This growth has been mir- ducing telemedicine - as it would help the country to
rored at GE Healthcare, where country director Haris overcome national healthcare burdens - there are some
Izmee explains that “we have been growing at a dou-
ble-digit rate over recent years and we expect to per-
INDONESIA MEDICAL DEVICE SECTOR
form above the market average in the next five years”.
MARKET SHARE
As with the rest of the Indonesian healthcare sec-
tor, medtech’s promising performance is being driv- USD1 BN MED TECH MARKET BY 2018
en mainly by the implementation of the Indonesian
Universal Healthcare Program (Jaminan Kesehatan
Nasional - JKN), which is boosting demand from
both public and private hospitals. GE Healthcare’s
Izmee elucidates that “JKN has also impacted our
private segment since more than 50 percent of the DENTAL PRODUCTS
inherent barriers to its implemen- this type of hospital because they classes. Indonesia is the largest
tation such as medical education have higher capacity levels and a source of medical tourism in the
and regulation.” higher quality level of healthcare region, mostly to neighboring
As with any disruptive technol- practitioners. By doing so, Philips countries such as Singapore and
ogy, education plays a key role is raising the bar of services and Malaysia. Both government and
in communicating not only the know-how by not only enhancing the industry are fully aware of this
benefits of such innovations but healthcare infrastructure but also patient outflow and are commit-
also ensuring that healthcare pro- contributing to the development ted to decisively increasing the
fessionals are correctly using the of human capital. Through these quality of service offered domes-
products. Philips’ Suryo explains types of initiatives we aim to cre- tically in order to retain these
that “We are closely collaborating ate not just a single impact on the patients. Siemens Healthineers’
with the government through dif- healthcare eco-system but rather a Lee affirms that “We aim to retain
ferent initiatives in teaching hos- systemic one.” those patients that are undergo-
pitals to provide them with not On the private side of the ing treatment abroad by offering
only the best equipment but also Indonesian market, opportunities them higher standards in technol-
the best medical education. We for the medical devices industry lie ogy and innovation in Indonesian
are concentrating our efforts on with the middle and upper-middle private hospitals.”
HARIS IZMEE
Country Director, GE Healthcare Indonesia
The corporate motto, “Healthymagination” aims to enhance healthcare quality, access and affordability in
order to bring better health to people. How is this global philosophy implemented in Indonesia?
Since GE Healthcare’s inception in Indonesia, we have always advanced alongside three main axes: en-
larging market access, improving quality, and enhancing affordability. In fact, we are continuously thinking
about these three pillars when undertaking business decisions and I am really delighted about the align-
ment with the current government goals.
We have totally transitioned from being product- to being solution-oriented, looking to only introduce
those products to Indonesia that can create healthcare breakthroughs targeted at local challenges, needs
and trends. Focusing on emerging markets and Indonesia, we are developing an affordable healthcare
portfolio that maintains the highest level of quality but only includes the most relevant features according
to our clients’ needs while at the same time making our solutions more accessible.
LOREMFROM
IPSUM PRODUCTS TO
DOLOR SIT SOLUTIONS
AMET
A
fter 14 years of management expe- Additionally, Suwignjo is also inspired by “the
Preface: A rience at US technology giant IBM, fact that by doing business we are also contribut-
Suryo Suwignjo was appointed pres- ing to a better quality of life for people.” The suc-
ident director of Philips Indonesia cess of the business can be seen in the fact that “the
in April 2014. Since then, the glob- company has been growing at a solid, sustainable
al Philips group has spun off its lighting business and healthy double-digit rate over the last three
and consolidated its consumer electronics and years.” In terms of ensuring a better of quality of
healthcare businesses in order to, in Suwignjo’s life for patients, Philips’ innovative medtech solu-
words “focus entirely on healthcare, offering an tions are helping bridge access gaps in a country
end-to-end solution covering the entire health con- where healthcare infrastructure is severely under-
tinuum – from hospital to home.” Consequently, developed, especially in remote areas. Suwignjo
Suwignjo’s priority has been to implement this is keen to highlight the tailored strategy that has
new strategy “of developing an integral solution been adopted in a diverse market with more than
that enables a treatment continuum between 5,000 kilometers of coastline and approximately
patients and doctors” across Indonesia. 17,000 islands; pointing out that “we have to listen
Suwignjo explains that the experience gained intently to our clients to be able to provide them
in his previous role at IBM has stood him in good exactly with what they need and shape our portfo-
stead for implementing change at Philips; point- lio accordingly.”
ing out that, “Philips is moving from being prod-
uct-oriented to being solution-oriented. IBM
passed through a similar change in the past when
it switched its business from hardware to software.
Hence, my prior experience is certainly helping me
to better understand as well as implement this stra-
tegic move, allowing me to apply my previously
acquired knowledge to the current context.”
Furthermore, Suwignjo is something of a trail-
blazer in that, as he notes, “even though Philips has
been in Indonesia for more than a century, I am
the first Indonesian president director.” He there-
fore feels a great motivation to perform well and
highlight the ability of Indonesians in prominent
management positions. He explains that his posi-
tion at Philips “allows and motivates me to show-
case the existing local professional capabilities in
Indonesia; Indonesians are able to lead prominent
multinational companies and bring their business
SURYO SUWIGNJO
to the next level.” PHILIPS
Our goal is twofold: to make the a shared services organization called 800 hundred and more physicians
right medicines available and to ena- Novartis Business Services (NBS), that we are engaging will then have
ble the right healthcare profession- which consolidated a number of the ability to reach out to thousands
als to prescribe them, i.e. enhance business support services currently and thousands of patients across
the skills of doctors in Indonesia spread across divisions. This syner- Indonesia to make their lives better.
and bring innovative medicines to gy allows Novartis divisions to focus
the country. more on customer-facing activities.
HCLS: What are the synergies HCLS: Innovation is within the WE ARE COMMITTED
between pharmaceuticals, oncol- core values of Novartis; hence, the TO LEVERAGING
ogy and eye care Business under company invests approximately NOVARTIS
Novartis Indonesia and how are 18-20 % of its total revenues in INNOVATION
you fostering them? developing R&D activities. How
MP: To achieve our mission of much of such innovation is go-
AND IMPROVING
improving and extending patients’ ing to be brought to the country INDONESIAN
lives, we have a program called in order to target the Indonesian PATIENTS’ LIVES.
“Customer First” in which all patients’ needs?
Novartis divisions collaborate on MP: We are committed to lever- HCLS: What are the three
initiatives that prioritize our cus- aging Novartis innovation and im- main objectives that you would
tomers, including the NHIP and key proving Indonesian patients’ lives. like to achieve in the upcoming
accounts, as well as provide value to To date, we have launched five new two years?
patients. medicines in Indonesia address- MP: As I have mentioned earlier,
In 2014 as part of an ongoing pro- ing Heart Failure, COPD, Multiple our goal is twofold: to make the
ductivity initiative, Novartis created Sclerosis, Psoriasis and Cancer. The right medicines available and to en-
able the right healthcare profession-
als to prescribe them, i.e. enhance
the skills of doctors in Indonesia
and bring innovative medicines to
the country.
In the upcoming years, we want
to further strengthen our col-
laboration with the Indonesian
Government, particularly the
Ministry of Health & Ministry
of Finance, in order to support
the NHIP and increase access to
Novartis products.
We aim to build up our team
competencies and send outstand-
ing Indonesian talents to Novartis
group companies overseas.
Last but not the least; we will
develop patient support programs
across key therapeutic areas in order
to help more Indonesian patients
gain access to innovative and effec-
tive treatments.
ANTIBIOTICS:
SOMETIMES LESS IS MORE
The World Health Organization (WHO), these days, considers anti-Microbial Resistance (AMR) an
emerging global menace with the number of afflicted patients forecast to increase dramatically in the
coming years. As the world’s fourth most populous nation, Indonesia now lies at the vanguard of fresh
efforts to raise awareness about this gathering storm and at the very heart of new initiatives to bolster
antiseptic usage and encourage proper prescribing behaviors.
A
ntibiotics are essential for the treat- A recent survey carried out by the Indonesian
ment of communicable diseases, but Caring Parents Foundation (YOP) found that 95
the bacterial resistance related to percent of doctors always prescribe antibiotics to
the consumption of anti-microbial their patients and 75 percent of them prescribe
drugs has radically curbed the ben- antibiotics for mild sicknesses, such as coughs.
efits of such medicines. The threat of AMR is well Indeed, these figures align with research conduct-
known and the WHO has categorized this global ed by the Indonesian Health Ministry back in 2013
health burden as one of the top threats to man- that demonstrated that only 27 percent of physi-
kind, with some 700,000 victims suffering from cians in Indonesia had prescribed the correct dose
antibiotic-resistant bacteria annually. Future fore- of antibiotics for their patients. Consequently, Dr.
casts are even more concerning: it is estimated Nila F. Moloek, Indonesian Minister of Health, has
that 10 million people will die annually due to this specifically requested that the Indonesian Doctors
health burden by 2050, according to the 2014 AMR Association (IDI) “design initiatives targeted at
Review. promoting the appropriate prescription and the
In Indonesia, however, a proliferation of inci- smart use of antibiotics by healthcare practition-
dence of anti-microbial resistance has not yet ers in the country.”
been adequately communicated in public health In parallel, many drug developers active in the
awareness campaigns. Furthermore, data on the local market believe they have a duty to support the
prevalence of AMR in Indonesia remains scant government in its efforts through the deliverance
and incomplete. Increasingly, however, policy- and roll out of educational and knowledge-sharing
makers, healthcare providers, clinicians and pri- programs. Mundipharma, for instance, stands out
vate industry actors alike are starting to acknowl- as a shining example to this effect. “Mundipharma
edge the dangers of allowing this status quo to is currently carrying out medical education initia-
prevail. In the assessment of Mundipharma’s tives within its Consumer Health division through
country manager, Mada Shinta Dewi, “AMR has its antiseptic Betadine® explicitly to fight against
become an increasingly significant national health antimicrobial resistance,” explains Shinta Dewi. “If
issue for our country, especially as we rank as one only patients were to use antiseptics before start-
of the largest antibiotics consumers globally.” ing an antibiotics treatment, significant strides
Meanwhile, the Indonesian Health Ministry has forward could be attained,” he affirms. “Thus we
set about creating a dedicated task force called regard it as part of our mission to raise awareness
the Antimicrobial Resistance Control Committee throughout the in-country medical profession as
(KPRA) in order to fight against the phenomenon to the immense benefits to be derived from sound
of antibiotics overuse. use of antiseptics.”
MORE THAN
SKIN DEEP
Holger Welters, president director at Beiersdorf Indo-
nesia, describes the company’s ambitious growth plan
for emerging markets and the importance of bringing
high quality skincare solutions to Indonesia through
Nivea® and Hansaplast®.
Holger Welters
BEIERSDORF
in line with the rate we have been enjoying in the past
few years. Naturally, what we started implementing in
2012 has been crucial to driving and delivering this
HCLS: In 2012, Beiersdorf introduced a corpo- growth. It enabled us to heavily invest in upgrading
rate strategic roadmap: “Blue Agenda”, which aims our manufacturing plant in East Java, which mainly
to strengthen brands, increase innovative power, serves the national demand. Looking ahead, we have
expand presence in emerging markets, and focus already put in place several actions that will secure our
on dedicated employees. How is this strategic plan sustainability as well as growth in the future.
reflected in Indonesia?
HOLGER WELTERS (HW): All Beiersdorf employ- HCLS: How is your offering structured here in
ees live and breathe the “Blue Agenda”, which means Indonesia?
that these guidelines are reflected in our daily opera- HW: Currently, we are solely commercializing the
tions. On a more corporate level, the “Blue Agenda” Nivea® and Hansaplast® brands. Our short-term
emphasizes that our core business is skincare and that strategy is focused on strengthening these two trade-
this is the area where we focus our capabilities such marks while in the long-term, we expect to introduce
as R&D, know-how, and investments. On a local level, other Beiersdorf brands such as Eucerin®. However, in
Beiersdorf Indonesia is offering skincare solutions order to successfully launch new products and guar-
through Hansaplast® for injured skin, and Nivea® for antee their longevity in Indonesia, many prerequisites
beautiful skin. need to be fulfilled, including strong market know-
With regards to expanding presence in emerging mar- how, an accurate strategy as well as the right team.
kets, we have started investing strongly in Indonesia
but also the Philippines since the Blue Agenda was HCLS: How do you foster the use of the Beiers-
launched in order to seize the immense potential these dorf brands to encourage an increased personal
markets bear. care mentality among Indonesians?
HW: Providing education about the benefits of our
HCLS: What is the significance of the Indone- products is crucial to enhancing the market penetra-
sian affiliate within the regional context? tion of our brands. There is a market but the need by
HW: Indonesia must deliver aggressive growth to our itself needs to be developed by communicating the im-
regional business. Therefore, we are targeting approxi- portance of skincare, the impact of its negligence and
mately +15 percent CAGR over the foreseeable future, the benefits of using our products.
PROTECTIONISM &
CLINICAL RESEARCH:
HINDRANCE OR HELP?
The Indonesian clinical research industry is highly underdeveloped, pri-
marily as a consequence of regulation issued back in 2010 that limits the
possibility of sending clinical trial materials outside of the country. Howev-
er, Indonesia has the potential to play a leading role in the regional clinical
trial landscape because of its large population, vast geographic area, as
well as the willingness of the domestic pharmaceutical industry to make
this a reality.
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