Increasing patient access to TB and HIV/AIDS treatments

Johnson & Johnson targets sub-Saharan Africa and Least Developed Countries to bolster access

Company

Johnson & Johnson

Location

Sub-Saharan Africa and Least Developed Countries; Globally

Focus

bedaquiline (Sirturo®)
darunavir (Prezista®)

Action

Broadening access to tuberculosis and HIV medicines

Aim

To apply equitable access strategies for high-burden diseases

Johnson & Johnson is a leading example in equitable access strategies, with an inclusive access strategy for two of its products that treat high-burden diseases, namely tuberculosis (TB) and HIV/AIDS. In fact, Johnson & Johnson goes one step further to supply its products to South Africa under terms similar to the ones it offers in supranational agreements, although South Africa procures those treatments outside of them.

Tuberculosis

The Global Drug Facility (GDF) for tuberculosis, established in 2001 and administered by the World Health Organization, ensures that national TB control programmes have uninterrupted access to high-quality medicines by providing direct procurement services and securing competitive prices.In collaboration with the GDF, Johnson & Johnson offers its recommended six-month TB treatment course of bedaquiline (Sirturo®) to more than 135 eligible countries for a not-for-profit price of USD 400 per course of treatment, which was reduced to USD 340 in July 2020.

The company recognises the disproportionate burden of disease in resource-limited settings together with its product’s potential to improve outcomes for patients with multidrug-resistant tuberculosis (MDR-TB). Johnson & Johnson also extends similar pricing terms to a country that does not benefit from the GDF’s supranational procurement assistance. In August 2018, South Africa announced it would move to all-oral second-line drug therapy for MDR-TB. Since then, the company has offered the country its six-month INN (Sirturo®) course at a price level in line with the one set forth in the supranational agreement (not-for-profit price).

Less than half of key products are covered by pharma companies’ access strategies in poorer countries

Access strategies with the biggest potential impact on access to medicine are strategies that aim to make products affordable for all patients across the income pyramid. The 2021 Index finds that many of the world’s poor countries still do not benefit significantly from pharma companies' access strategies.

HIV/AIDS

For sub-Saharan African and least developed countries, Johnson & Johnson sets a ‘special effort’ price for its HIV/AIDS product darunavir (Prezista®). To set this price, the company uses an inter-country equitable pricing framework that considers the economic conditions and disease burden of each country, together with its public health need for the product. The company evaluates countries by gross national income per capita at purchasing power parity (GNI PPP) and measures severity of disease burden across countries. It also considers impact of the disease on economies, the proportion of a country’s population paying out of pocket for healthcare or lacking access to health insurance and demographic factors such as income levels.

The ‘special effort’ price enables distributors to make a fair profit while keeping the price sufficiently low to ensure maximum coverage. Chemonics International, a supranational procurement organisation, benefits from this price to procure darunavir. The company extends similar terms to South Africa, a country directly procuring the treatment. Johnson & Johnson has also issued a non-assertion declaration for this product in sub-Saharan Africa and least developed countries, allowing generic medicine manufacturers to enter the market.

How we measure

The Index evaluates pharmaceutical companies in areas where they have the biggest potential and responsibility to make change, such as R&D and pricing. Find out more about the analytical framework and areas of evaluation.

A new, tighter analytical framework for 2021

The 2021 Access to Medicine Index is based on a new analytical framework of three Technical Areas, and 14 priority themes for corporate activity. Per area, companies’ policies and practices are measured by indicators that correspond to pharmaceutical companies’ core role for improving access to medicine. The new analytical framework for 2020 has a tighter structure, with 33 indicators grouped into three Technical Areas: Governance of Access, Research & Development and Product Delivery.

Analytical Framework for the 2021 Access to Medicine Index — The 2021 Access to Medicine Index analyses company behaviour using a framework of 33 indicators organised in three Technical Areas.

3 core areas of responsibility

A Governance of Access Looking at how companies govern, plan for and manage the achievement of access-linked objectives, while ensuring they apply processes that minimise the risk of non-compliant or corrupt behaviour occurring. It looks at access-to-medicine strategies, including whether they are aligned with corporate strategies, and how progress towards access to medicine objectives is measured and incentivised.

B Research & Development Looking at pharmaceutical companies R&D activities to develop or adapt products for the diseases,conditions and pathogens within the Index scope, and in response to the needs of people living in low- and middle-income countries. It also examines whether companies put plans in place during development to accelerate access to successful products for people living in low- and middle-income countries.

C Product Delivery Looking at companies’ post-development actions on the ground to ensure they offer equitable access to their products and overcome any local barriers in accessing hard-to-reach markets and patient populations. They can then use three main access strategies: equitable pricing, responsible IP management and product donations. These are considered to have the biggest potential impact on supply and affordability. Actions such as sharing intellectual property and health-system strengthening are also considered here.

Distilling global priorities for access

Each Access to Medicine Index is the product of a two-year process known as the ‘Index cycle’, which begins with a review of the Index methodology. This process aligns the Index metrics with changes in access-to-medicine priorities and stakeholder consensus on what we expect from pharmaceutical companies to improve access to medicine. We also use the review to reaffirm the robustness of the next Index analysis, and ensure our capacity for trend analysis is maintained.

The latest review, held in 2020, led to the methodology for the 2022 Access to Medicine Index.

Increasing patient access to TB and HIV/AIDS treatments

Less than half of key products are covered by pharma companies’ access strategies in poorer countries

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How we measure

A new, tighter analytical framework for 2021

3 core areas of responsibility

Distilling global priorities for access

Get in touch

James Hazel