A research programme by the Access to Medicine Foundation

Pricing, Manufacturing & Distribution

Affordability depends on who is going to pay – the patient, government or another stakeholder in the local healthcare system. In low-income countries, up to 70% of spending on medicines may be made out of pocket. Different populations have different incomes and expenses. Companies must recognise this when pricing their products.

  • Commitments
  • Transparancy
  • Performance
  • Innovation
1 = GlaxoSmithKline plc

GlaxoSmithKline plc

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2 7 Gilead Sciences Inc.

Gilead Sciences Inc.

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3 = Novartis AG

Novartis AG

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4 8 AstraZeneca plc

AstraZeneca plc

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5 16 Takeda Pharmaceutical Co. Ltd.

Takeda Pharmaceutical Co. Ltd.

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6 4 Sanofi


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7 5 Novo Nordisk A/S

Novo Nordisk A/S

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8 20 Roche Holding AG

Roche Holding AG

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9 = Merck & Co., Inc.

Merck & Co., Inc.

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10 2 Johnson & Johnson

Johnson & Johnson

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11 6 Merck KGaA

Merck KGaA

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12 18 Boehringer Ingelheim GmbH

Boehringer Ingelheim GmbH

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13 15 Pfizer Inc.

Pfizer Inc.

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14 = Eisai Co. Ltd.

Eisai Co. Ltd.

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15 11 Bayer AG

Bayer AG

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16 12 Bristol-Myers Squibb Co.

Bristol-Myers Squibb Co.

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17 13 Daiichi Sankyo Co. Ltd.

Daiichi Sankyo Co. Ltd.

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18 10 AbbVie Inc.

AbbVie Inc.

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19 = Astellas Pharma Inc.

Astellas Pharma Inc.

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20 17 Eli Lilly & Co.

Eli Lilly & Co.

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0 1 2 3 4 5

Gilead and Novartis new in leading group; use of equitable pricing improves

GSK (1st) is a clear leader. It is followed by Gilead (2nd) and Novartis (3rd) in the leading group. The top three are followed by two additional companies (AstraZeneca and Takeda) that outperform the rest, and a closely ranked group of 12 companies (Sanofi to Daiichi Sankyo) ahead of three laggards. Rankings in this area primarily reflect the depth and breadth of companies’ equitable pricing strategies and how far they are being applied in priority countries*. More companies are demonstrating progress, both when it comes to considering socioeconomic factors when setting prices, and in the proportion of priority countries covered by equitable pricing strategies. Leaders apply more equitable prices and register some new products in priority countries and for higher proportions of their portfolios than their peers.

Leaders target countries most in need

GSK (1st) is a clear leader. It is followed by Gilead (2nd) and Novartis (3rd) in the leading group. These three are generally top performers in: (1) taking account of multiple socioeconomic factors when setting prices; (2) applying equitable pricing strategies to large proportions of products and/or in priority countries; and (3) filing to register some new products in priority countries. 

GSK (1st) held its lead by expanding its equitable pricing strategies to 60% of its products in scope for at least one priority country. Almost all its products in priority countries (96%) are linked to equitable pricing strategies based on multiple socioeconomic factors. Gilead (2nd) joins the top three, expanding its use of equitable pricing strategies to cover 94% of its relevant products, up from 50%. Gilead and GSK have both committed to filing all new products for registration in countries in scope within a year of first global product launch with reference to public health needs. 

Novartis (3rd) maintains its position of third but improved its performance in equitable pricing, as did its leading peers. In 2018, 57% of Novartis’ relevant products are covered by equitable pricing strategies targeting priority countries (compared to 49% in 2016).  

Risers apply more equitable pricing strategies

Most movement is at the top and bottom of the ranking. Two companies, Gilead and Takeda moved into the top five by linking more products to equitable pricing strategies covering priority countries. Many companies (14) improved their use of socioeconomic factors when setting prices and linked more strategies for equitable pricing to priority countries than in 2016, contributing to a growth in the average number of factors taken into account per strategy from 0.7 in 2016 to 3 in 2018. 

Takeda rises 11 places (to 5th), making a strong pledge to equitable pricing and registration in priority countries, and going from 0 to 10 products with intra-country equitable pricing strategies, all linked to multiple socioeconomic factors. Roche rises 12 (to 8th), significantly increasing its transparency across all areas. 

Johnson & Johnson falls 8 (to 10th). It did not keep up with peers in its use of equitable pricing strategies and socioeconomic factors to set prices, or in widely filing to register its newest products in relevant priority countries. AbbVie falls 8 (to 18th) primarily due to a drop in transparency.

Middle group expand pricing and registration practices

AstraZeneca (4th) and Takeda (5th) lead the large middle group primarily due to an increase in the consideration of more socioeconomic factors per strategy on average compared to the other middle- ranking companies. 

Improvement in the middle group is largely in the scope and scale of equitable pricing strategies and registration practices. E.g., Novo Nordisk (7th) now files to register half of its newest relevant products in the majority of corresponding priority countries. Additionally, it is the only company to file to register all of its new products in at least one priority country. These companies also generally perform above average in aligning supply and demand. 

AbbVie (18th), Astellas (19th), and Eli Lilly (20th) perform poorly across many measures. Eli Lilly and AbbVie are markedly less transparent than in 2016. AbbVie edges past its peers to 18th, as it files more of its newly launched products for registration in the majority of corresponding priority countries. 

*Priority countries are disease-specific subsets of countries with a particular need for access to relevant products.

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View our detailed overview of each company’s performance in the Index, including breakdowns of their product portfolios and R&D pipelines.