Equitable access strategies are a crucial element of product delivery. Pharmaceutical companies need to increase their patient reach ensuring that patients from all income levels have access to life-saving health products, particularly first-line treatments.

GSK demonstrates best practice with an inclusive access strategy that takes affordability into account. Through its joint venture with ViiV Healthcare, it has entered into supranational procurement agreements through which eligible countries can obtain dolutegravir (Tivicay®), an antiretroviral therapy for HIV/AIDS. GSK offers this at cost price (covering manufacturing and distribution costs only) to public HIV programmes and international donor agency programmes (e.g. US President’s Emergency Plan for AIDS Relief (PEPFAR) initiative) in all least developed countries, low-income countries and all sub-Saharan African countries. By doing so, GSK is expanding access to this first-line therapy until generic formulations become available.

Supplying a middle-income country

On a related action, an equitable pricing strategy has allowed ViiV Healthcare to increase coverage in middle-income countries not eligible to procure dolutegravir (Tivicay®) as part of its supranational offer. For instance, a flexible pricing policy has enabled ViiV Healthcare to agree a high-volume, low-cost supply of the medicine with the Brazilian Ministry of Health. By 2019, Tivicay® had become Brazil’s leading HIV therapy, with a third of the 900,000 people living with the condition using this medicine. This access strategy is further supported on the ground through ongoing access-related initiatives such as “Positive Action” which enables HIV testing.

Expanding accessibility through MPP

ViiV Healthcare is a specialist HIV company, majority-owned by GSK, with Pfizer and Shionogi Limited as shareholders. In 2014, ViiV Healthcare signed two non-exclusive voluntary licensing agreements with the Medicines Patent Pool (MPP), allowing generic medicine manufacturers to produce and sell single and combination versions in countries with the highest HIV burden. Currently, 18 companies are licensed to manufacture versions of Tivicay® (including a newly developed fixed-dose combination) in 95 countries for adults and 121 countries for children globally. In November 2020, MPP and ViiV Healthcare signed a new voluntary licensing agreement to enable greater access for dolutegravir-based regimens (adult formulation) in certain upper-middle-income countries (UMICs). This new licensing agreement includes Azerbaijan, Belarus, Kazakhstan and Malaysia.