September 20, 2020

"The medicine of the future to be personalized, very soon when one is born will have its genome" – La Provincia

"The medicine of the future to be personalized, very soon when one is born will have its genome" - La Provincia


The president of HEFAME, in the warehouse where they store medicines worth one hundred million euros. Photo: Álex Domínguez

The HEFAME plant In Murcia, where the headquarters are located, it is an imposing complex in which thousands of medicines and parapharmacy products are received and distributed every day. Its activity, however, is not limited to exercising an effective and necessary logistical work, it goes much further. Carlos Covés, president of this cooperative, the third in Spain, opens before our eyes a wide range of services. The prototype pharmacy office installed behind the doors of the main building is the best showcase that, although it looks like the pharmacy of the future, is already a reality and in it, the professional pharmacist who is Covés moves like a fish in water. It describes the functional distribution of the establishment and the options available to the client: from the mere dispensing of the formula that the doctor has prescribed to the new range of facial care of the house or to the offer of comprehensive health care. Supported by new technological applications, the pharmacist can do a comprehensive monitoring of your patient, adapt your treatment or prevent the development of diseases of genetic origin.

-What does today's pharmacy offer compared to the traditional pharmacy?
-In recent years we have worked on three projects. One has been the online sale, of which we are very proud. The great asset that the pharmacy has is that any client has one to a maximum of 150 meters from his home and you can choose to pick it up at home or there. We all work outside and it is better for you to spend at any time. Since our partners are pharmacists and owners of the cooperative, the pharmacy will bill it.

– The competition is internet, Amazon?
-It's the question they always ask me. When I was raised for the first time, I answered that I thought Amazon was a great idea. There you have the results. You have to copy how well someone does things and adapt them to your reality. Amazon has a good thing, variety. We have set up an online sale adapting it to our sector. The added value that we give is that, when you come to pick it up at the pharmacy, you always find a health professional who will support you if you want.

"The important thing is the patient, it is at the center of our strategy, we digitize everything we do so you can include it in your electronic file"

– Do you run the risk of turning the pharmacy into a supermarket?
-Never. Exclusivity has been lost, people buy where they want, where they give better service or better price. I would prefer that everything be exclusive sale in pharmacies, but the same laboratories have decided where to put their products. The great value of the pharmacist is that he not only sells.

– And the second project?
– It's our strategic plan. The truly important part of our mission is the patient, we have put him at the center of our entire strategy. The world and society have changed and new services and needs are being created. People live more and more years and need care at home and control their polypharmacy. We digitize what we do every day in the pharmacy: when you want to take your blood pressure at home or sugar level or weight, we give you the opportunity, instead of stamping it on a piece of paper, to do it in your electronic file, with the which will be recorded in your history. Through an application that we give away, the data will come directly to my computer, so that you can follow your own parameters, but in turn the pharmacist controls your medication, your constants. And there is a system of traffic lights where I am going to tell you: your tension has gone a little high, reduce the salt, take the medication or I send you directly to the doctor because it is urgent. You know that you are controlled at all times, not only by your doctor, but also by your pharmacist. And, now that chronic patients go to the specialist once a year, you will go through the pharmacy and I will give you a report with your constants that specifies what has happened to you during that time. It will be very useful for the healthcare professional to have a control of yours too.

– The third project is the study of the genome?
– It tends to personalized medicine. The patient can go to the pharmacy, buy a genetic test for 250 euros, which we have developed with the University of Valencia, and, with only one swab of cotton in the saliva, in fifteen days his entire genome is provided. You will be in a world bank of genetic maps for life. This has many applications: it will tell me if I have a chance to develop a disease, it will give me permission to the pharmacy or the doctor to access that genome at any time … There are medicines that I will be able to decide if they are or not good for you or if you can not take them because of your genetics. That will allow me to be very effective in the treatment. Also, I will be able to predict diseases. There are some in which you can not do anything, but there are others that develop or not depending on your type of life and food, or environmental factors. So I will be able to redirect them and avoid them. In the very near future, when one is born, it will have its genome.

The pharmacist Carlos Covés, in the offices of the cooperative in Murcia. Photo: Álex Domínguez

-The risk is the custody of the information.
-We have it perfectly organized, the patient allows or does not access that data. And you also have to be careful because people will be afraid to know or will cause anxiety if you say "you have a chance of developing a cancer or Alzheimer's." We will be very careful.

– The medicine of the future will be personalized?
-Totally. It will be a product influenced by genetics and, say, biological and directly designed for that type of patient. All the research that is being developed goes through two paths: Alzheimer's and cancer and some disease, such as ALS. There is a lot of talk about, instead of aggressive medication, stimulation medication from our own defenses, but the breakthrough will be when we find something for dementia and for cancer. Other diseases will appear, because with age the organs deteriorate, as do the neurons. More than extending life, we must have quality of life. This is a cycle that you initiate, you live, you reproduce and you die. And we have to have a dignified death, in which we can decide ourselves when we want life to end. I do not agree with maintaining life at all costs. If you have a good brain, you can be perfectly integrated into your environment and your family, but if you do not have a good brain, what are you doing here? Give what to do That we have to decide now that we are well: "hey I do not want to live anymore if I do not know my people or if I'm not going to have a minimal relationship".

-The parapharmacy depends on the economic cycle?
-The parapharmacy has increased by purchasing power and self-care and information. The people of today are more concerned about our health than before and we have possibilities to buy dermopharmacy or parapharmacy products. That has increased despite the crisis. Another thing is that with the crisis we were affected mainly by pharmacists because the Administration, which is our main client in medicines, did not have money to pay us. We suffer a lot. After all, the distribution and the pharmacy is the same, we are the owners of the distributor. When the pharmacist does not pay the Administration, the pharmacist does not pay the distribution. We have had a very bad time.

"Health should return to the State and offer equal services in all regions"

-The margins of medications have also tightened
-Approximately, every three months there is a reference price order where the medicines go down, basically the generic ones. With the aggravating circumstance that the Administration gives you twenty days to sell at a new price. If a medicine is worth ten euros and you have it on the shelf and you lower it to eight, you have twenty days to invoice it to ten. If not, the following month you have lost those two euros. Multiply by the number of drugs we have on the shelf. And that creates a huge loss for both the pharmacy and the distribution. We have here more than one hundred million euros of "stock".

– Is the innovation for the laboratory?
-Va on behalf of the laboratory. There has been a phenomenon in recent months, which is the shortage, there were a lot of products that were not in the Spanish pharmacy. There are people who blamed us, when what interests us is selling. We are in a globalized world and, when medicines fall in Spain, they find other, more expensive markets.

-We have been told that the cause is Brexit.
-It may affect England, but not the rest of Europe. Forget about Brexit. The duty of the Administration is to save, but when you lower the medicines too much and the manufacturer has the product already sold, if Spain has, for example, one hundred thousand units, he will try to give him fifty thousand. The other fifty thousand will sell them at twice the price in other countries such as India, China or emerging countries. Try to get the maximum return.

– Does the Administration indirectly cause shortages?
-I do not want to accuse anyone. The Administration wants to give the best service at the best possible price and the industry wants to sell its products with the maximum benefit.

"There will be more mergers between cooperatives to gain size and be able to invest in new technologies"

-With that policy, is consumption at least rationalized?
-In Spain we have a universal and free public health, and that is a mistake. Health, like all services, must be rationalized and controlled. When a thing is free it is not valued. In fact, we use Urgencies with a criterion … When the pensioners, who are the ones who consume the most medicines, paid eight euros at the most per month for their medication, it was curious. At the pharmacy he would call people and ask: "Why do I have to pay for this?" And you answered: "Well, lady, 50 cents." And he said "well do not give it to me, I have left". There came a moment that the Government said: 37% of pensioners do not take their medication because they do not have money. And I said: a pensioner charges, the least, 426 euros per month: do not you have 8 euros to spend on your health? Hard to understand. Buy bread, drink coffees, go to the movies or pay for electricity. It was a curious thing … On January 2, when the law changed and they said "the pensioners no longer pay", they all came and said: "I have learned that I do not have to pay anymore". "What does he want?" "If I do not have to pay, give it to me." Automatically, consumption increased by 20%. As an entrepreneur I am happy, but as a citizen this can not be allowed by a country.

-What is the efficient model?
-We have to rationalize. A co-payment based on income would be more logical. The problem is that we have seventeen legislations that create a distortion of citizens. Health should provide the same services in one community and in another. Honestly, it would have to be in the hands of the State. Pharmaceutical management is, changes the pharmaceutical legislation of each community.

– Should we liberalize the pharmacy concession?
– That question I did when I finished the race and did not have a pharmacy. Everything has its advantages and disadvantages. If we analyze the pharmaceutical model of the liberalized zones, such as the Anglo-Saxon one, where with the title you can already put a pharmacy, it turns out that there is one every 20,000 inhabitants and it does not have an emergency service. In one regulated, like Spain, there is one every 2,000 inhabitants. In a country with the liberal model, you can not find a pharmacy in a village or a coña, but in the big avenue of the big city there are 50. In a model like Spanish, which is the best in the world for the citizen, live in In the center of Madrid or in a small town with 500 inhabitants, you have the same pharmaceutical service, do not you? And to that pharmacy, when you ask for a medication and they do not have it, they tell you: come back in two hours, why do you think it happens? Is there a fairy godmother?

-There is the cooperative.
-The Spanish pharmaceutical model, which is the best in the world by far, is supported because the distribution is a cooperative of all pharmacists. And the difference between a company whose sole objective is to give benefits and a pharmaceutical cooperative is that we move by sanitary criteria, not only economic ones. In 50% of the shipments we make to pharmacies, we lose money. How much is it worth to send a bag 2 or 3 times a day to a village that is 50 kilometers away? A company that moves only for money will take that for free to a single citizen? That box that is worth, maybe, only cents? The model is supported by the cooperative and by pharmacists. And all our effort is for the patient to have their medications when and where they need them, totally free.

-What are you doing, a vocational pharmacist, a president of a cooperative?
-Where I have a good time is in my pharmacy. Fortunately, I can be here because I have two pharmaceutical daughters, but, as I come out, I'm in love with my profession and I do not want to lose touch. If you lose touch with your profession, you lose reality. My role in HEFAME is to mark, direct the strategy and control that everything works in the best possible way. This is a team in which everyone has to function as a piece of watchmaking. When they ask me who are the most important of the company I always say: the drivers, those who go three times a day to take the medicines. Because if that driver does not do his job well, the client or patient will not have his medicine, the pharmacist will get angry, will not buy from the cooperative and we will go bad. Fortunately, we are oversaturated in all the warehouses, many times we can not grow more in the company because we lack space.

– Grow in what?
-In services and geographical area. We are giving a good service. Also the other competing cooperatives. Good results are not magic, but work well done. The important thing about cooperatives, that we sometimes get lost with the internet and parapharmacy, is to take to each place the medicines at the scheduled time, that there are no mistakes, that the pharmacist and the client can have all the medicines they need at the right time. and at a reasonable price. The price differences between some distributors and others are very small. The great leap of HEFAME right now is digital. We are at the technological head both internally and in the face of pharmacies. We have put pharmacies at a point capable of responding to the new challenges that are arising in society. It is what we are most proud of.

– Will there be more mergers between cooperatives?
– Yes, there will be more and more concentration. Very few years ago there were some 262 distributors. Today, 32 and decreasing.

-To take advantage of economies of scale?
-Yes. And because the large laboratory multinationals are no longer in the business of serving small distributors. They have the market already sold. If you sell 100,000 aspirins in Spain, the laboratory does not care to sell them to 30 distributors than to 300, therefore, you want to distribute them if possible to three, because it reduces your cost, your billing, your risk of charging, etc. The small cooperatives, if they do not have size and financial muscle, will hardly be able to invest in the new technology that is needed today. There have been many mergers a couple of years ago. Vidafarma, which were eight or ten small cooperatives of Andalusia, have joined in an excellent project and created the second cooperative in Spain. We are the third. Things have their moment. What I want is to continue agglutinating the distribution in Spain, but always that people feel comfortable. I will try to make agreements with whomever I want. In the end we will be three, four or five large distributors.

The data of Hefame

  • Billing: 1,345 million euros
  • Employees: 1,000
  • Services: 6,000 pharmacies
  • Orders: 47,000 daily
  • Coded references: 80,000

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