A research programme by the Access to Medicine Foundation

2018 Ranking

The 2018 Access to Medicine Index finds that the pharmaceutical industry continues to mature in its approach to access to medicine, with models for good practice in areas such as access planning and licensing. GSK retains its No. 1 position, as Novartis moves up into 2nd. Takeda rises furthest in 2018, jumping ten places to fifth.

1 2 GlaxoSmithKline plc
4.40

GlaxoSmithKline plc

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2 3 Johnson & Johnson
4.24

Johnson & Johnson

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3 1 Novartis AG
3.75

Novartis AG

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4 7 Novo Nordisk A/S
3.26

Novo Nordisk A/S

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5 9 Pfizer Inc.
3.04

Pfizer Inc.

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6 = Merck KGaA
2.43

Merck KGaA

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7 10 Takeda Pharmaceutical Co. Ltd.
2.35

Takeda Pharmaceutical Co. Ltd.

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8 = Sanofi
2.29

Sanofi

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9 19 Roche Holding AG
2.24

Roche Holding AG

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10 4 AstraZeneca plc
2.16

AstraZeneca plc

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11 14 Eisai Co. Ltd.
2.00

Eisai Co. Ltd.

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12 17 Boehringer Ingelheim GmbH
1.97

Boehringer Ingelheim GmbH

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13 18 Gilead Sciences Inc.
1.55

Gilead Sciences Inc.

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14 13 Bayer AG
1.22

Bayer AG

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15 5 Merck & Co., Inc.
1.15

Merck & Co., Inc.

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16 12 AbbVie Inc.
0.86

AbbVie Inc.

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17 10 Astellas Pharma Inc.
0.85

Astellas Pharma Inc.

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18 16 Bristol-Myers Squibb Co.
0.74

Bristol-Myers Squibb Co.

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19 11 Daiichi Sankyo Co. Ltd.
0.51

Daiichi Sankyo Co. Ltd.

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20 15 Eli Lilly & Co.
0.34

Eli Lilly & Co.

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0 1 2 3 4 5

Insights

  • GSK and Johnson & Johnson pull into top spots

    GSK and Johnson & Johnson overtake Novartis to gain the lead. They are followed by three groups of companies: three good performers ahead of a middle group of six, and a large group of laggards. Most of the companies in the top ten build diverse capacities around the world.

  • Leaders innovate and measure impact

    The two leaders, GSK and Johnson & Johnson, perform strongly in all five areas examined. They are measuring the impact of specific initiatives and both demonstrate innovative approaches to health systems strengthening. They have 29 initiatives between them that meet all standards of good practice looked for by the Index.

  • Upward movement reflects quality of initiatives

    There is movement up and down the ranking due to focus in 2018 on the quality of capacity building initiatives. In previous years, the Index assessed the total number of initiatives companies run. Companies move up or hold on to higher rankings by showing that initiatives meet more good practice standards. 

  • Three good performers shine in multiple areas

    Novartis, Novo Nordisk and Pfizer are the three good performers chasing the leaders. Each scores well in four of the five areas examined. Novo Nordisk also has an innovative new initiative to provide people with basic care and treatment for hypertension and diabetes during humanitarian crises.


Overall, progress is led by a handful of companies, including in pricing and R&D

The pharmaceutical industry continues to mature in its approach to access to medicine, with more companies assigning responsibility for access initiatives at the board level, three companies issuing new or strengthened access strategies since the 2016 Index, and pricing strategies that set different prices for different segments of a country’s population (intra-country pricing) are becoming more sensitive to different population’s abilities to pay.

Read the ranking deep dive


How the companies compare in 7 areas

The Access to Medicine Index covers seven areas of corporate behaviour. In each one, the Index evaluates 20 of the world's largest R&D-based pharmaceutical companies against a list of responsibilities for improving access to medicine as they enter low- and middle-income countries.

General Access to Medicine Management

As pharmaceutical companies search for new opportunities in low- and middle-income countries, they have a responsibility to also increase access to their products. Achieving this requires companies to view access to medicine as a strategic issue and to manage it as such, with clear goals and objectives and commitment from top management.

Learn more about General Access to Medicine Management

Market Influence & Compliance

Pharmaceutical companies operate in an environment where the pressure to maintain profits and a fiercely competitive landscape can increase the temptation to engage in inappropriate, unethical behaviour. For example, offering inappropriate incentives to doctors increases the risk of irrational prescribing decisions. Strong policies and procedures for ensuring compliance are critical for mitigating this risk.

Learn more about Market Influence & Compliance

Research & Development

There is huge demand for R&D that meets the needs of people living in low- and middle-income countries. For example, new products are needed for infectious diseases such as malaria, as well as for tropical parasitic diseases. Large R&D-based pharmaceutical companies are best placed to develop such products and bring them to market.

Learn more about Research & Development

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. Pharmaceutical companies must recognise this when pricing their products.

Learn more about Pricing, Manufacturing & Distribution

Patents & Licensing

How companies manage their intellectual property (IP) impacts the availability and affordability of medicines. This has been demonstrated by the game-changing engagement between R&D-based manufacturers and generic medicine manufacturers in the global market for HIV/AIDS medicines. Pharmaceutical companies have an obligation to manage their IP rights responsibly. 

Learn more about Patents & Licensing

Capacity Building

Some of the biggest barriers to access to medicine relate to gaps in local pharmaceutical and health systems. Companies can draw on their capabilities and expertise to increase the availability of quality-assured, safe and effective medicine and healthcare, while helping to build and strengthen future markets. 

Learn more about Capacity Building

Product Donations

Donations of medicines and other products are an important tool for improving access to medicine in specific circumstances, such as to control, eliminate or eradicate diseases impacting the poorest populations in the world. To safeguard the access that donations bring, it is important that companies remain engaged until eradication or elimination targets are achieved, or work with governments on transition plans for when the donation programme ends.

Learn more Product Donations

Four leaders consistently outperform peers once again

The 2018 Index is led by GSK, followed by Novartis, Johnson & Johnson, and Merck KGaA. These are the same four companies that led in 2016. They most consistently invest in projects that the global health community has identified as pressing priorities with either no or low commercial incentive. They frame access as a business proposition, and all are among the leaders in multiple areas of evaluation.   

GSK retains first place for the sixth consecutive Index. It continues to outpace peers, supported by and building on its long-standing foundation of projects, initiatives and policies. GSK leads in 5 out of 7 of the areas that the Index analyses. During the period of analysis, GSK has shown itself to currently be the most access-oriented company in the Index.  

Novartis rises one place to take second rank, having climbed every Index since 2012. Over the period of analysis, the company has expanded the scope of its access efforts, embodied in the Novartis Access Principles, which promises to integrate access-oriented thinking across the company’s pipeline. Its pipeline covers both non-communicable diseases such cancer and COPD and communicable diseases such as malaria.

Johnson & Johnson remains in the top three companies for the fourth consecutive Index.  The company remains an access leader, with a robust internal structure for ensuring coherent, senior governance of access in selected disease areas, and a strong approach to capacity building that aligns with stakeholder expectations. The company has expanded its global health focus since 2016, for example to newly include mental health. 

Merck KGaA holds fourth place for the second consecutive Index. Since 2016, it has created the Merck Global Health Institute and launched a new business model, Curafa™, addressing primary healthcare in Kenya. The company has particular strength in targeting R&D priorities and in the systems it has in place to minimise the risk of corruption and unethical marketing. 


Diverse strengths from middle-ranking companies results in close competition

Following the top-ranked group of companies are Takeda and Novo Nordisk, in 5th and 6th place respectively. They lead a broad mid-ranking pack of companies stretching to Bristol-Myers Squibb in 15th place. Takeda has climbed the most in rank since the 2016 Index after jumping 10 places and performs particularly well in two core areas the Index evaluates – R&D and pricing. Fractionally behind Takeda, Novo Nordisk takes a particularly high-quality approach to capacity building, including its efforts to increase children’s access to diabetes care. 

Scores are particularly densely packed between Sanofi in seventh place and Gilead in 13th place. This group has similar scores but for very different reasons; the strengths and weaknesses are diverse, with each company choosing to focus its efforts more or less in different areas the Index measures. With scores this close, comparatively small shifts in performance can trigger a significant rise or fall in rank.

Following closely behind are Boehringer Ingelheim and Bristol-Myers Squibb, in 14th and 15th place respectively. Boehringer Ingelheim has pulled out of the lower rankings of the Index with a strengthened access strategy but is held back by a comparatively poor performance in attaching access plans to products in its pipeline.


Of the five lowest-ranking companies, three have yet to set strategies

The tail of the Index is populated by a group of five companies, comprising Bayer, AbbVie, Daiichi Sankyo, Astellas and Eli Lilly. Of these five, only Bayer and Eli Lilly have strategies in place for improving access to medicine, leaving Astellas, Daiichi Sankyo and AbbVie as the three remaining companies out of the 20 evaluated in the Index yet to develop an overarching approach for their access activities.  These three companies tend to engage in access initiatives on an ad hoc basis. All the companies in this lowest-ranking group placed in the bottom quartile in at least three out of the seven areas of evaluation. 

Bayer, ranked 16th, placed in the bottom quartile in three areas. AbbVie fell eight places to rank 17th, with scores in the bottom quartile in four areas. Daiichi Sankyo, which ranks 18th, places in the last quartile of five areas. Although it rose one place to 19th in this Index, Astellas placed in the bottom quartile in four of the areas of evaluation and in the bottom half of the remaining three. Eli Lilly falls 3 places to rank 20th. Its performance is relatively weak across all of the seven areas the Index evaluates, and is less transparent than its peers across multiple measures. The company holds the last position in three of the areas.


The methodology

The 2018 Index analyses the actions of 20 pharmaceutical companies to improve access to medicine in 106 low- to middle-income countries for 77 diseases, conditions and pathogens. It uses an analytical framework of 69 metrics to evaluate companies’ actions where they have the potential and the responsibility to make change: including in compliance, R&D, pricing and licensing.

Learn more about what the Index measures



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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.