Affordability 'mindset' applied to diverse health products
Novartis applies its Novartis Access Principles to develop sustainable equitable pricing strategies that aim for maximum reach.
Applying access strategies to supranationally procured, healthcare-administered and self-administered products
To offer sustainable equitable pricing strategies for maximum patient reach
Equitable pricing strategies can play a significant part in increasing access to medicine. The Index looks for companies to focus on the needs of local populations and integrate access strategies into the delivery of their health products. In line with this objective, Novartis has established the Novartis Access Principles, which entail innovative pricing, refocusing research and development based on society’s healthcare needs and supporting approaches to strengthen healthcare systems.
Supranationally procured products
Through Sandoz, its generic division, Novartis is increasing access to three important tuberculosis (TB) medicines (pyrazinamide/ethambutol/rifampicin/isoniazid [Rimstar 4-FDC®], rifampicin/isoniazid [Rimactazid®] and clofazimine [Lamprene®]) through supranational procurement agreements. The Global Drug Facility (GDF) was established to ensure uninterrupted access to high-quality anti-TB drugs for national TB control programmes. Each year, Sandoz meets with the GDF to understand price and supply challenges and expectations, taking account of the previous tender’s awarded price, competitor price points, manufacturing costs and currency fluctuations as it sets its own price point.
Healthcare practitioner-administered products
The Index looks for companies to consider how their access strategies can be tailored to increase the reach of medicines administered by healthcare professionals. The Index expects companies to look at both public sector agencies (such as national authorities and public insurance) and private sector entities (private insurance and the ‘out of pocket’ patient market) when considering ‘ability to pay’. For these, specific access challenges may exist in low- and middle-income countries.
In India, Novartis has addressed such challenges by working with its in-country partner Cipla to launch an emerging market branded version of omalizumab (Xolair®), a treatment for asthma to serve different income strata, in parallel to the original brand to improve affordability. The emerging market brand was launched at 10% of the original brand price. The company also takes into account the challenges to access diagnostics for asthma and negotiated with a diagnostics company to obtain spirometry tests in bulk at a discounted rate. It passes on this discount to the government and out-of-pocket patients. By doing so, it increases product reach for this innovative asthma treatment and strengthens the health system diagnostic capacity.
In India, Mexico and the Philippines, Novartis has launched lower-priced emerging market brands (EMB) of self-administered products to enhance affordability.
Self-administered products – Emerging market brand strategy
Novartis demonstrates best practice in how it applies its access strategy to several self-administered products. This type of products, typically treating non-communicable disease such as diabetes, heart diseases and cancer, is vital to the patient but may not be prioritised by governments or the global health community. To address affordability of self-administered products in three countries (Mexico, Philippines, India), the company, in line with Novartis Access Principles, makes available Emerging Market Brands (EMB), which are generally priced at significantly lower price than the global average for the original brand.
In Mexico, to treat migraine, Novartis has launched an emerging market brand for erenumab (Aimovig®). This aims to increase affordability and access in the public sector and ensure affordability for individuals who pay for this medicine themselves. For the latter, the company has a patient support programme (PSP) based on data from a National institute of Statistics and Geography survey of national income and expenses and on market research into ability and willingness to pay. This allows Novartis to set accurate thresholds to differentiate prices.
When patients enrol for the product through a prescribing physician, an external independent vendor completes a socioeconomic evaluation to determine how many vials of Aimovig® an individual can afford during the course of a year. Novartis then provides the balance to cover full treatment. Patients also use an app to record migraine diaries and help physicians monitor outcomes. Novartis estimates an additional 24 million people gain access.
Novartis has also launched an emerging market brand for Aimovig® in the Philippines, with a sophisticated PSP that takes into account affordability in public and private sectors. It has also engaged a variety of stakeholders to strengthen the system to manage migraine disease, initially focusing on the workplace.
Novartis applies the same EMB in India to address affordability for two other products in its portfolio sacubitril/valsartan (Entresto®) for the treatment of ischaemic heart disease and ribociclib (Kisqali®) for the treatment of breast cancer.
Do companies extend access terms for countries outside supranational agreements?
This part two of a four part series, describes how supranational agreements help solved access challenges and takes a look at whether companies extend the same terms of access for their products to countries which are not covered by these agreements.
Novartis Access and a new business model in sub-Saharan Africa
Novartis Access (NA), a programme for non-communicable diseases (NCDs), comprises a portfolio of 15 products aligned for the treatment of 4 main diseases: cardiovascular, respiratory, cancer and diabetes. All medicines are branded in a dedicated pack with the Novartis Access logo indicating the active ingredient rather than the original brand name. The commitment by Novartis is to offer the products to governmental programmes in low-income countries (LICs) and LMICs primarily at prices of USD 1 per month and per treatment. At the end of 2019, Novartis took a new approach in sub-Saharan Africa (SSA). The SSA unit aims to maximise patient reach across the full income pyramid by focusing on tiered pricing models, competitiveness in tenders and scaling social business models as well as affordability strategies.
Uganda falls under the company’s new sub-Saharan business model and benefits from availability of two anti-diabetes medicines in differentiated packs (original brand and NA branded) and prices, offered according to an income pyramid, the NA NCD programme and portfolio in Uganda is aligned with the local government’s agenda. Where a patient’s income comes at the top of the pyramid, Novartis offers vildagliptin (Galvus®) and vildagliptin/metformin (Galvus-met®) for a competitive, higher price. Where income is at the bottom level and patients procure medicines in private market, the company offers NA vildagliptin at a lower tailored price. It also trains pharmacists to enhance their capacity to allocate the most suitable medicine pack to the right patient. Novartis is working with the Joint Medical Store (a local faith-based not-for-profit distributor) to build an entry into the Ugandan market and reach the lower income patients directly with lower-priced medicine in the private sector.