In an interview with BioPharma BoardRoom, Cem Zorlular, CEO of Er-Kim, shares his personal journey and the driving force behind Er-Kim's mission to tackle the inequity of drug access outside core markets. As a third-generation leader of Er-Kim, Cem's commitment to this cause stems from a deeply personal experience with his father's battle with esophageal cancer. Since taking the helm at Er-Kim, Cem has been dedicated to realizing a vision where all patients, regardless of location or economic status, have equal access to life-saving treatments. Here, he discusses Er-Kim's unique approach, challenges encountered, and aspirations for the future in shaping global healthcare standards.

What inspired your personal commitment to addressing the inequity of drug access outside of core markets, and how does this drive shape Er-Kim's overall vision and mission?

As a third-generation representative of Er-Kim, a leading regional commercialization partner for global biopharma companies founded in 1981, my mission to improve drug access to all patients is a personal one. In 2017, my father was diagnosed with esophageal cancer, a quite rare and aggressive form of the disease. Throughout my father’s treatment, my family personally experienced the extent and impact of drug inequity as we sought access to some treatments even we could not procure. After my father’s passing in 2019, I joined Er-Kim as CEO with a vision to fix the inequity of drug access in areas wherever there is unmet need so that all patients in need of essential or innovative treatments have an equal opportunity for long, healthy lives.

After joining the firm, what I soon came to understand was that although the company had been improving access in our region - and has continued to make good progress there - more needs to be done to close the gap in drug inequity in more regions in a more comprehensive manner. This realization made us reexamine why we exist - what it is that makes us want to come to work every day - and it’s because we believe strongly that every patient deserves the same level of attention as their peers in the US or the Western World. Our mission is to deliver alternative models for commercialization in our region that can be both easy and economically attractive, resulting in these regions being considered a priority rather than an afterthought.  

Can you elaborate on the specific challenges you've encountered in expanding access to treatments for rare diseases outside of traditional markets, and how Er-Kim aims to overcome these challenges?

We always ask ourselves the important question of why patients in need are not getting the same level of attention as their peers. Fixing drug inequity can start at the boardroom level where budgets and commercial strategies are set. When considering a commercialization strategy, pharmaceutical companies will generally only look at a few markets outside of the US, Western Europe, and Japan. Outside these core markets, traditional pharmaceutical commercial models can be more difficult to sustain in part because some regions include a high number of countries with smaller individual market sizes. Despite some challenges, however, well-designed, customized business models can make many of these markets profitable, while improving access for patients in need.  

• Economics:  Many of the markets that we operate in have smaller populations (under 50M), and for biotechs that have a limited portfolio of products, it may not seem economically sustainable for them to launch their products and set up operations where there are slightly to moderately lower net prices for treatments with a smaller number of patients. Therefore, on an individual product basis, companies do not believe it makes fiscal sense to expand their operations to those smaller markets, but collaboration with regional partners that conduct due diligence on smaller markets can result in a launch strategy that works for both companies and patients.
• Agility Required for a Constantly Changing Landscape: In many of the markets in which we operate, change is constant. Although traditional launch plans follow a waterfall methodology, a more agile strategy may be required in some of our markets, but this should not be viewed as a downside, necessarily, since the market changes, that can limit access and can also result in the possibility for patient access to increase rapidly. In creating customized models, we strive to manage risks in the regions where we work, and are always mindful of the need to adapt quickly when required.
• Compliance & Quality: Downside risks can be higher in some countries. When considering business models to launch products, companies will also need to consider investing in areas such as compliance teams to manage the distribution of products from the manufacturer to the patients at the highest standards to ensure quality and traceability. 
• Healthcare Infrastructure: In many countries where we operate, in addition to critical medications, a robust overall healthcare infrastructure is lacking. The absence of mechanisms in place to educate providers and patients on new treatments could be the main reason a drug might not get market access, or might not be able to reach patients despite market access accomplishment.

In what ways does Er-Kim's international markets-first model differ from traditional pharmaceutical approaches, and how do you see this approach impacting patient outcomes on a global scale?

This really goes back to our mission of fixing drug access one country at a time, and asking ourselves: “How do we get biopharma boards excited about these markets when traditional models have not worked in the past?” I mean this concept beyond the philosophical – because ethically we all want to broaden access -  to include commercial success. The question then becomes how to reach patients, while delivering revenue (and doing that fast) without burdening a company’s operations that are most likely already stretched thin. To enable that, our core ingredient has been our culture.

For us it means two things: building a customized model to get treatments to patients as quickly as possible through a patient-first approach, and delivering long-term, sustainable, and cost-effective strategies to our partners. 

Considering your advocacy for global partnerships, could you discuss how Er-Kim identifies and collaborates with key stakeholders to advance its mission of broader patient access to treatments?

In recent years, we have seen an increase in partnerships with US- and European-based biotechs looking to expand treatments in areas where they do not have a presence. Through our local affiliate presence and global infrastructure, we’ve built a team of highly talented, entrepreneurial individuals that support our mission to drive market access for patients that need innovative treatments. Diversity of background is the key. We look to hire talented candidates from all areas of industry, from research-based organizations to those in the medical field, to NGOs and others that represent the patient perspectives that can really connect with local stakeholders and build win-win partnerships. Our operating model, then, is not pushing a set global launch plan per se, but having our local teams pull us to deliver what is needed for patients. 

How does Er-Kim balance the pursuit of commercial success with its commitment to addressing healthcare disparities and improving patient outcomes, particularly in regions where access to treatments is limited?

We don’t think commercial success and addressing access disparities are mutually exclusive, in fact, we believe a true solution to broadening access can and must be a sustainable path to commercial success for all stakeholders. A “pull model” can make more stakeholders incentivized, and also improve local ecosystems by sourcing, hiring locally, and skills transfer.   

Looking ahead, what are your aspirations for Er-Kim in the next five to ten years, and how do you envision the company contributing to the evolution of global healthcare systems and patient care standards?

Our goal for the next five years is to expand our business model and deploy it globally, to ensure access to all novel medicines across all regions and at every price point. Through our customized partnerships, we hope to solve the unique distribution challenges of an increasing number of pharmaceutical partners, enabling a larger number of patients to access needed treatments as rapidly as possible, regardless of where they live.