Eli Lilly’s CEO on the good, the bad… and the beautiful?

As CEO of a 141-year-old Big Pharma company and a member of the PhRMA board, Eli Lilly’s David Ricks has a fairly good platform for surveying the healthcare ecosystem.

He can – and does – talk at length about its flaws. But he’s also a reservoir for optimism when it comes to innovation in hard-to-treat diseases and progress in the drug development world. That includes fields such as Alzheimer’s disease and lupus, which have defeated Lilly (and the rest of the field for that matter) many times before.

In an interview with MedCity News on Wednesday, the third day of the BIO International Convention, Ricks discussed his company’s newly expanded R&D facility in San Diego, California, the challenges of drug discovery, and the ultimate reward.

The good…

Innovation and productivity are always a challenge for Big Pharma, so the unveiling of Lilly’s new expanded R&D facility warranted some celebration.

“We’ve found we’ve grown because we’ve been successful,” Ricks said simply.

San Diego’s success is part of a model that includes many smaller-scale remote sites, each with a “theme” or two, such as neuroscience, Big Data, immunology, or oncology, he said.

“People organically interact with different disciplines and different expertise. And that’s where innovation comes from; it’s different points of view and experiences colliding.”

From an external perspective, the company’s foothold in San Diego also gives it access to the local biotech ecosystem and world-class academic collaborators. Lilly has a number of partnerships on the go, including some important work with the Sanford Burnham Prebys Medical Discovery Institute developing checkpoint targets for immunology, he said.

That’s all well and good, but teamwork doesn’t necessarily get a drug over the line. And many of the diseases Lilly tackles remain incredibly hard to treat. How do we shift resources in that direction to address unmet needs?

“So right now, I think you would have to say is the era of oncology. Something like half of the venture-backed investment is going into oncology companies. That’s because there’s a good market, but it’s also because there’s a massive opportunity for innovation, because of biological understanding,” Ricks explained.

That biological understanding has been lacking in Alzheimer’s and autoimmune diseases in the past. We’re now on the cusp of filling those knowledge gaps, he said. In fact, the progress in oncology is informing autoimmune disease research — it’s “the other side of the immune system” after all.

Pain management is another example.

“It’s the largest category of prescriptions in the world,” Ricks stated, and there hasn’t been any innovation in 50 years. Eli Lilly now has Phase 3 programs for migraine-related pain and osteoarthritic pain, channeling new pathways and targets.

A lot of the advances are being made in diagnostics and biomarkers, which Ricks is enthusiastically embracing.

“RA [rheumatoid arthritis] is the big one that everyone talks about. Why is it that some patients respond to therapy A, but not B? Why is it that B-cell depletion, like with Rituximab, works in 20 percent of patients but not in the other 80? It must be a heterogeneous thing and teasing that apart — we now have the tools to do that.”

The final piece of the puzzle is technologies that allow us to capitalize on that scientific enlightenment, with more efficient and more effective drug development. To that end, Lilly’s satellite facilities are implementing automation, robotics, Big Data, deep learning and AI.

Ricks seemed particularly excited about innovations in clinical trials.

“I mean we’ve got so much more sophisticated about both the patient selection cycles, those tools, but also execution,” he shared. “One area we’ve really done a lot of innovation in is Alzheimer’s.” 

The problem is that Alzheimer’s trials are large and the outcomes measured remain pretty crude, Ricks said. So to operate more efficiently, Lilly has an initiative underway to enroll a pre-screened pool of potential study participants — before the trial(s) even gets off the ground. The population can be stratified by factors such as amyloid status, to fast-track the enrollment process and ultimately, the length of the trial.

“It’s such a race now, there’s not a moment to spare,” he said.

The bad…

As everyone knows, the battle doesn’t end with an FDA approval.

“Obviously there’s a lot of frustration with the drug pricing topic,” he lamented. “If you talk to Wall Street, they’re very frustrated with it because they see us as not having the pricing leverage we used to. Which is ironic, I think, because on the other side people are frustrated because they feel like we have all this pricing leverage we’re exploiting people.”

Ricks believes one of the core problems is the changing model for insurance design, which is impacting the affordability of medications for people with chronic illnesses.

“A lot of those costs have been shifted to those patients and we think that’s wrong,” he said. “The point of insurance is – independent of your health status –you pay in and if you get sick, it takes care of you. That works more or less for surgeries, but it’s not working for pharmaceuticals. We pay four times as much out-of-pocket for drugs than we do for surgeries.”

Ricks has a simple solution, which both Lilly and PhRMA support. Insurers should pass through the rebates they negotiate so that the patient benefits as well. It seems intuitive, but almost all copays, coinsurance schemes, and deductibles are based on list prices, he said.

“That’s something we need to change quickly.”

Long term, Ricks believes all the different stakeholders should take into account that medicines “are one of the best deals going in healthcare.” As a medical intervention, they’re far more cost-effective than surgeries or in-patient care, he argues. 

On the other hand, he readily acknowledges that drug pricing is just the tip of the iceberg.

‘It’s a complicated system. It’s probably too complicated.”

Which brings us to the beautiful…

Ricks has now spent two decades rising through the ranks of Eli Lilly, working in various roles. It begs the question: Are there specific career highlights or moments that make it all worthwhile?

“I joined the company really at an exciting time,” Ricks recalled.

The company was launching a lot of new medicines, which is, after all, the ultimate goal of any biopharma company.

“Just being able to see how collaboration and innovation can change the treatment of patients,” he said, was extremely gratifying.

Still, there’s nothing quite like the moment your team realizes they have an effective therapy on their hands.

During his tenure as general manager of Lilly Canada from 2005-2008, Ricks was involved with some important psoriasis clinical trials. Sometime after, he ended up talking to an investigator from one of the busiest trial sites.

“I said, when did you know it was a medicine? And she said, well about a week after I dosed my first patient,” Ricks recounted.

The patient had gone home and her plaques (skin lesions) had literally shed from her body as she slept. For someone who had struggled with psoriasis, it was understandably an incredible moment.

So much so, that “she bought the plaques in, in a bag, which I guess when you’re a dermatologist is interesting,” he laughed. “She’s like, I never in years of practice saw something like this.”

And that, in a roundabout way, is what’s beautiful about the work biopharma companies do, developing drugs and changing lives.

Photo: Eli Lilly