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.
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GlaxoSmithKline plcRead more
Merck KGaARead more
Novartis AGRead more
|3||=||Eisai Co. Ltd.||
Eisai Co. Ltd.Read more
|4||=||Roche Holding AG||
Roche Holding AGRead more
|6||2||Novo Nordisk A/S||
Novo Nordisk A/SRead more
|6||13||Takeda Pharmaceutical Co. Ltd.||
Takeda Pharmaceutical Co. Ltd.Read more
|7||16||Bristol-Myers Squibb Co.||
Bristol-Myers Squibb Co.Read more
Pfizer Inc.Read more
|9||6||Johnson & Johnson||
Johnson & JohnsonRead more
Bayer AGRead more
|11||7||Merck & Co., Inc.||
Merck & Co., Inc.Read more
|12||17||Astellas Pharma Inc.||
Astellas Pharma Inc.Read more
AstraZeneca plcRead more
|14||18||Boehringer Ingelheim GmbH||
Boehringer Ingelheim GmbHRead more
|15||12||Eli Lilly & Co.||
Eli Lilly & Co.Read more
|16||1||Gilead Sciences Inc.||
Gilead Sciences Inc.Read more
AbbVie Inc.Read more
|18||15||Daiichi Sankyo Co. Ltd.||
Daiichi Sankyo Co. Ltd.Read more
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Three new leaders: GSK, Merck KGaA, Novartis
GSK rises to 1st from 9th in 2016, with a clear lead. Merck KGaA and Novartis both climb to joint 2nd place. They are followed by two tightly clustered groups of companies: from Eisai in 3rd to Takeda in 6th, and from Bristol-Myers Squibb in 7th to Merck & Co., Inc. in 11th.
Leaders have strong approaches to compliance
GSK and Novartis have strong internal control frameworks for ensuring compliance, including auditing of third parties, and systems for continuously monitoring compliance. Along with Merck KGaA, they are also top performers in other areas, including their codes of conduct for ethical marketing and anti-corruption.
Two clusters in the middle ranks
Companies in 3rd to 6th place report ethical marketing and anti-corruption codes that meet industry standards, and processes for third-party compliance. Eisai, Roche and Takeda decouple sales agents’ incentives from sales targets. Companies placed 7th to 11th give varying performances and less transparency.
Middle group can strengthen compliance controls
Middle-ranking companies report fewer components of internal control frameworks to prevent and sanction corruption, bribery and unethical behaviour. Although many have an audit and reviewing mechanism, most lack one or more of the additional components that the Index looks for.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.