2021 Ranking

GSK and Novartis are in close competition and are leading performers across the three main areas of measurement: governance of access, research & development and product delivery. For example, they implement equitable access strategies for the majority of products analysed, taking patients’ ability to pay into account, and providing evidence that additional patients were reached through their access strategies. They continue to address local access barriers through capacity building initiatives, while evaluating the outcomes of their activities.

GSK has the largest pipeline of projects targeting established R&D priorities (81) and of late-stage projects covered by access plans (20/25). Novartis stands out for being the only company to apply equitable access strategies in at least one low-income country for all products assessed, as well as for implementing scalable and inclusive business models.

The companies ranked 3rd to 9th have all incorporated access-to-medicine across the different areas of their businesses, with an access-to-medicine strategy that is linked to a business rationale. The majority are also implementing structured processes for developing access plans during R&D. With the exception of Pfizer, however, these companies do not keep pace with the two leaders when it comes to taking a patient’s ability to pay into consideration. 

Johnson & Johnson leads this group in 3rd place. It has a robust set of compliance controls to safeguard its governance efforts, performs well in capacity building, and has access plans in place for a relatively large proportion of its relevant R&D (44% of late-stage projects). Pfizer follows in 4th and newly in the top five, applying access strategies to the majority of products analysed. It leads in addressing access to self-administered products across different regions and socio-economic groups, demonstrating increases in patient reach. Together with Sanofi in 5th, these two companies perform well in capacity building for manufacturing, supply and health system strengthening. Sanofi is also notable for its strong performance in product donations.

Takeda in 6^th performs particularly well in equitable access strategies for health-care practitioner administered products and access planning. It falls behind in areas such as product registration, local manufacturing and product donations. AstraZeneca in 7th is a leader in its approach to intellectual property management, committing to not enforce patents in most Least Developed Countries, low-income countries, and a subset of lower-middle income countries and upper-middle income countries, as well as disclosing patent status for its products in scope. 

Merck* takes 8th place, with a relatively large R&D pipeline, and strong involvement in IP-sharing agreements and donation programmes. However, it misses opportunities to improve access to products in lower-middle and low-income countries, as does Roche, which closes the group in 9th place. Roche has scaled up its Global Access Programme, a long-running inclusive business model now running in 82 countries and covering four additional infectious diseases.

*Merck KGaA (Darmstadt, Germany)

Following closely behind Novo Nordisk are Eisai (11th) and Boehringer Ingelheim (12th), with average performances across all areas. Boehringer Ingelheim has increased the coverage of access plans across its late-stage pipeline, and has launched In Reach Africa to strengthen NCD care in Kenya. Eisai maintains its strong performance in product donations, and remains committed to eliminating lymphatic filariasis. Bayer (13th), Gilead (14th) and Astellas (14th) all have at least one R&D project that targets a priority gap and is covered by an access plan.

Bayer has taken concrete steps to improve the accessibility of products analysed, filing to register the majority of its most recently approved products in priority countries. It has also begun publishing patent statuses and disclosed a new commitment not to enforce patents in all low-income countries. Astellas is one of the few companies in scope not to have applied its access-to-medicine strategy across its business, yet it does set access-related incentives for its CEO.

The tail is populated by five companies that place in the bottom quartile in the three main areas of measurement due to poor performance: MSD** (15^th), Daiichi Sankyo (16^th), AbbVie (17^th), Eli Lilly (18^th); Bristol Myers Squibb (19^th). AbbVie, Bristol Myers Squibb, Eli Lilly, Gilead and MSD are among the least transparent companies in scope, choosing not to disclose information across a range of issues, nor to make relevant information available in the public domain. With the exception of Bristol Myers Squibb, they did however continue to engage with the Index on specific data points, with AbbVie and Gilead disclosing additional details not already in the public domain.

Together with Astellas, AbbVie and Daiichi Sankyo are the only companies in scope of the Index that do not have an access-to-medicine strategy linked to a business rationale. Bristol Myers Squibb takes the bottom rank. Since 2018, Bristol Myers Squibb has narrowed its global health focus by leaving many areas in the infectious disease product development space. 

**Merck & Co., Inc (Kenilworth, NJ, United States).