INTERVIEW: Ramona Sequeira Rolls Out Takeda's American Dream

Just one month before Ramona Sequeira joined Takeda Pharmaceutical Co. Ltd. as its US president, Christophe Weber – himself newly installed as CEO in April 2015 – announced that the firm had "hit bottom". Japanese generic competition, Actos settlements, and a lot of noise about a potential deal exit with Contrave (naltrexone/bupropion) development partner Orexigen Therapeutics Inc. hit the headlines and Takeda's profits.

There is no doubt that Sequeira joined Takeda at a difficult point in its history, at a time when it was settling most of the US product lawsuits relating to its type 2 diabetes drug Actos (pioglitazone) for a total of around $2.4bn (with no admission of liability). The claims related to Actos' possible links to bladder cancer, and whether the company provided sufficient warnings after the drug's US launch in 1999. The litigation meant the firm posted a full-year loss in its fiscal 2014 financials.

Enter Ramona Sequeira, the first and only woman on Takeda's executive team: calm, confident and not afraid to make impassive decisions. She is not about to have sleepless nights, she explains. "I am not a natural worrier, I definitely feel that the best way to address issues is to think about them, to take them as unemotionally as possible and try to figure out how you move forward."

Ramona Sequeira

Sequeira is very clear about where she sees opportunities for the Japanese pharmaceutical giant in the US. Her tone is friendly and conversational but her messaging, as the Americans would say, is on point. Direct, clear and never a redundant word used – it is obvious why she has been chosen by Weber as the person to drive Takeda's strategic overhaul in the company's second largest market. The US forms approximately 40% of the global pharmaceuticals market, for Takeda this figure is about 27%. Organic growth and investment in areas where the company can lead are all part of Sequeira's strategic remit.

Joining from Eli Lilly & Co. - where she was vice-president of Lilly USA - Sequeira spent the first four months of her role in listening mode. She spoke with Takeda's employees, its payers, partners and patients to ascertain what Takeda was doing well and what it could do better. Then, she had the task of creating a strategy that would fit the ambitions and challenges of its US stakeholders in a market that is moving faster than ever.

The overarching message she heard "loud and clear" was the need to engage and support patients more closely than it had previously. "Part of our strategy involved a reinvestment of our resources towards patient-centric initiatives, whether that is patient support programmes or just giving really credible unbiased information to patients. In the US, in particular, patients are paying for more and more of their healthcare and they have to make decisions on how they are going to spend their money, and so there is a strong need for information and insight, and we are trying to meet that."

Armed with her research, Sequeira rolled out Takeda's US strategy in the end of 2015. It included strengthening its focus on recent product launches in inflammatory bowel disease (IBD) and major depressive disorder, including the creation of business units to capitalize on opportunities.

“Takeda is focusing resources behind opportunities where we can lead," Sequeira announced at the time. "We are making very deliberate strategic choices on where we will invest, and where we won’t. We want to ensure we are focused on areas where we can provide the most value for patients over the long-term."

One of the decisions that had the biggest impact was the agreement to transfer back to Orexigen the rights to develop and commercialize Contrave (naltrexone/bupropion) in the US, allowing Takeda to better focus promotional resources against its portfolio of medicines in areas such as depression, IBD, gout and diabetes. (Also see "Orexigen Insists It Can Grow Contrave After Takeda Exit" - Scrip, 15 Mar, 2016.)

Changing Structure

Sequeira says she has a "strong compass and a strong radar". The radar tells her what's happening in the environment while the compass shapes a response. She is not afraid to walk away from a sale if it is not right and doesn't create value. "Christophe was looking for a leader who had that internal compass, but then also created a structure that allowed leaders to be very agile and I have a lot of autonomy and authority to do what I need to do to grow our business in the US," she explains.

"I don’t have to go through a huge bureaucracy to make changes in my own organization," she says. "When Christophe is hiring leaders he is going to give a lot of autonomy to, he wants to be able to trust them. He is not here every day, he is not monitoring everything I do; he needs to be able to trust me. I think that is very important at Takeda."

Sequeira is very open about the changes required to maximize Takeda's business in the US. The big pharma's functional model did not allow the company in the US to take the integrated approach that was needed for commercialization, which is what its customers needed it to do as the US healthcare system evolves, she explains. Agility and adaptability are very important in the fast-paced American market, she stresses. The functional model means that siloes occur and people stay "in their swim lane". "We weren’t stepping back and looking at the patients across their entire journey with their disease, and so the idea of forming these business units and creating this new structure and investing in some of these capabilities was really to help us be more agile and responsive to our market."

Sequeira refers to two new business units: a specialty business unit, which will drive patient support and evidence generation, and general medicine business unit to support operations and marketing of the company’s medicines in the areas of central nervous system (CNS), gastroenterology, gout and diabetes.

"There was a time when our market, maybe a decade ago, wasn’t responding as quickly as it could have been, and companies at that time felt it made sense to build up a lot of infrastructure, but then when their market starts moving that infrastructure becomes a bureaucracy and slows you down," she says. Nimble growth and investment are also part of the American masterplan. While the ulcerative colitis and Crohn's disease drug Entyvio (vedolizumab) and Brintellix (vortioxetine) – or Trintellix as it will be known in June - are having "nice growth", investments are being made in driving much needed innovation. There are R&D houses in both Chicago and Boston, with the latter also home to a global vaccines hub and Takeda's global oncology business. It has just purchased a biologics manufacturing plant in Minnesota that will be used to make Entyvio. "We are making sure that we have got the ecosystem working here and the full value chain in the US," she explains.

But of course it is not just about US drivers for the global company, Takeda's mission is to scale its Japanese success worldwide. "That’s what Christophe’s journey is all about, we are just starting that. We definitely punch way above our weight in Japan, but we are not as well known outside and so we aspire to be as well known in other countries as we are in Japan now," she says while pointing out that being known as a Japanese company is not a bad thing as that culture revolves around trust and obligation to customers and to society. "We carry that with us, and that is a good thing. We want to take advantage of what being a Japanese company means to us and how that can help us do business differently, but then we also want to be a global company that can play globally."

Looking at life from an international perspective came early to Sequeira. Born in Canada to "non-traditional" immigrant parents from India who had moved across the world to marry in secret, she describes a childhood where there was no pressure to conform from her parents, both of whom are psychologists. "There was always the belief that you could do anything. I never felt like there were certain jobs that were off limits, I never felt pressured to get married and stay home."

Despite the lack of pressure from her parents, Sequeira studied molecular genetics and molecular biology at the University of Toronto, and later received an MBA from McMaster University in Canada. She worked at Lilly USA for 21 years before her role at Takeda, a company she had "very little interaction with" prior to joining.

She recalls a conversation with the president of Eli Lilly when she was working in a marketing director role at the company. Asked about what the next step was in her career, Sequeira said she couldn’t give any more than she already was. "He gave me this really enlightening piece of advice: 'as you rise up in leadership, you don’t have to give more, you just have to give differently. You have to find ways to help the whole organization achieve its goals versus you working to achieve your goals'. I think he helped me understand that as a mother and as a wife, I could still go on and have greater leadership positions and be able to have a good family life. That was a real eye-opening moment for me."