Access initiatives for cancer products focus on pricing, mainly for small populations
Cancer is taking an increasing toll in low- and middle- income countries, where more than half of deaths due to cancer now occur. The Index examines company efforts to increase access to cancer products for the first time this year, focusing on cancer medicines deemed by the World Health Organization to be essential for all healthcare systems.*
In this first assessment, the Index compares cancer products on the 2017 WHO Model List of Essential Medicines (EML) with other WHO EML products, such as HIV/AIDS medicines and antibiotics. It found that around the same proportion of cancer products on the WHO EML have access initiatives attached to them as products for other diseases do, with initiatives in place for just over half of products (57% vs 54% respectively).
The largest proportion of access initiatives for cancer involve pricing initiatives. However, they generally have limited coverage aiming to reach fewer people than initiatives for other WHO EML products. Pricing initiatives on average apply in fewer than five priority countries, most commonly middle-income countries such as Egypt, Pakistan and Mexico. Conversely, for communicable disease products on the WHO EML, equitable pricing initiatives are applied to many low-income countries in South Asia and sub-Saharan Africa. Moreover, no cancer medicine is covered by voluntary licensing. Pricing and licensing are core tools for improving access to medicine.
Initiatives mainly focus on pricing
All access initiatives evaluated for cancer products were either pricing or donations initiatives. In both categories, initiatives can take the form of Patient Assistance Programmes (PAPs), where products are made available at low or no cost and target smaller groups of patients per programme (compared to, e.g., donations programmes targeting neglected tropical diseases). These programmes are supported by ancillary activity involving, for example, the training of healthcare workers, patient education, and screening and diagnostic services, thereby recognising the need to strengthen health systems ill-equipped to manage cancer care. No cancer medicines are covered by licences. However, two companies, GSK and Merck KGaA, have stated they are open to using voluntary licensing for cancer medicines in the future.
Figure: Access initiatives mainly focus on pricing, for cancer and other EML products
Which companies market the most cancer products on the WHO EML?
Out of the 20 companies evaluated, 14 market a total of 72 cancer medicines that are on the WHO EML. Novartis markets the largest proportion of these, including half of the cancer products that have an access initiative. The remaining products with pricing initiatives are spread between seven other companies.
Access planning for cancer products is lagging
The Index has also assessed whether companies plan ahead during development to make future products more accessible in low- and middle-income countries. By this measure, access planning for new products for non-communicable diseases – and particularly cancer – lags far behind planning for communicable disease products. The access plans are mostly commitments to register new products in low- and middle-income countries, overwhelmingly in China and occasionally in Brazil. Some access plans also involve commitments to flexible pricing in key countries, but the impact of those commitments is unclear, as most companies did not reveal where and to what extent they will apply.
Plans for donation programmes cover one cancer medicine: Novartis’ chronic myeloid leukaemia treatment nilotinib (Tasigna®), which was recently approved for use in children one year of age and older. The company uses a combination of pricing mechanisms and donations to address access to the medicine in India, Pakistan, Egypt and China. It works with the Max Foundation to donate and distribute Tasigna® in 40 additional low- and middle-income countries.
Figure: Access planning for cancer products in development is lagging
Pharmaceutical companies can work with national governments and partners to expand pricing schemes, particularly for poorer patients, and donation programmes where appropriate. Companies are also strongly urged to begin systematically planning ahead during clinical development to ensure successful products can be made widely available more quickly in low- and middle-income countries. They can pioneer voluntary licensing for cancer medicines, and establish multi-sector capacity building partnerships.
A 2017 study by the Access to Medicine Foundation found the companies evaluated to be carrying out many diverse capacity building initiatives related to cancer care. The 2018 Index confirms this finding, with most initiatives examined for health systems strengthening focused on cancer. Many health systems, particularly in low- and middle-income countries, lack the infrastructure and investments to be able to offer the full complex range of cancer care services.
Health systems in developing countries also need to be sufficiently strengthened by governments and their partners before sustainable health outcomes for cancer patients can be achieved.
Figure: Overall, 14 companies market 72 cancer medicines on the EML
* There are 27 cancer types in scope for the 2018 Access to Medicine Index: 17 for the R&D analysis (based on the top 10 highest global incidence rates, highest incidence in countries in scope and highest proportion of global incidence in countries in scope), and 19 for the areas of analysis relating to pricing, patenting and donations (i.e., cancer products on the WHO EML).