Access strategies: Context Part I

How do companies ensure worldwide access to their products?

This part one of a four part series, describes how the Index assessed whether companies tailor their access strategies to reach patients across the income pyramid and how they overcome-specific access barriers.

About this series: How do companies ensure worldwide access to their products?

Context Part I: Overview of how the Index assesses' companies access strategies for three categories of products: supranationally procured products, healthcare practitioner administered products, and self-administered products.
Results Part II: Supranationally procured products
Results Part III: Healthcare practitioner-administered products
Results Part IV: Self-administered products

Strategies with the biggest potential impact for access
Ultimately, affordability depends on who is paying and the constraints they face. This is why pharmaceutical companies must think in terms of who is going to pay. This can range from government-run health systems to patients paying out of pocket right across the income pyramid – including those at the very base.

The base of the income pyramid is the largest and poorest socio-economic group — Access strategies with the biggest potential impact on UHC are strategies that aim to make products affordable for all patients across the income pyramid.

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. Yet, there is no ‘one-size-fits-all-products’ approach to access to medicine. How companies consider access can depend on the product. For example, medicines that need to be administered by a healthcare professional can face a number of diverse access challenges in low- and middle-income countries — particularly in weaker healthcare systems where there may be poor infrastructure and patchy health services.

Defining access strategies

In general, companies can use three main access strategies to increase access to medicine in countries in scope:

Equitable pricing strategies: Setting prices within the ability of specific populations to pay, with reference to a range of socioeconomic factors;

Responsible intellectual property (IP) management: Licensing agreements under pro-access terms and/or pledges not to enforce patents to facilitate generic entry; and

Product donations: Identifying populations with no capacity to pay for the new product and donating products as appropriate in collaboration with local partners.

What sample of products did the Index assess?

To see how companies tailor their access strategies to reach a larger proportion of the income pyramid and how they overcome barriers when dealing with different products, the Index looked at three different categories of products:

Supranationally procured products: Products linked to international pooled procurement, market-shaping facilities and significant public funding and donor support, such as vaccines.

199 key products controlled by pharma companies — These products are considered essential for a well-functioning healthcare system and require strong access strategies to boost access.

Healthcare practitioner (HCP)-administered products**: Products that often require either hospital administration of the product or the attention of a skilled healthcare professional during administration such as IV-administered cancer treatments.
Self-administered products**: Products that can be administered by the individual patient, including treatments for diabetes and heart disease.

For each category, the Index analysed a sample of a maximum of five products per company, resulting in a total of 199 medicines and vaccines that are considered essential for a well-functioning healthcare system and for which large companies hold a controlling position regarding access – determined either through patents or their dominance of the market.

Results

To dive into the results and see what access looks like for each of the three product categories, see the following:

For this analysis, the Index analysed a sample of the companies’ portfolio products, looking at a maximum of five products per company.

* Based on the definition used by: Business Call to Action. Implementing Inclusive Business Models. How Business Can Work With Low-Income Communities.; 2015. https://www.unglobalcompact.org/library/3161. Accessed December 18, 2020.

** Weak access strategies with a low performance score were not included in this analysis. For a fine grained view of individual company access strategies, see the Report Cards.

What does access look like for healthcare practitioner-administered products?

This part three of a four part series, describes how medicines that need to be administered by a healthcare professional can face a number of access challenges in low- and middle-income countries. This analysis looks at whether companies tailor their access strategies for these products to reach a larger proportion of patients in these countries.

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.

What does access look like for self-administered products?

This part four of a four part series, looks at whether companies tailor their access strategies for self-administered products, which are particularly useful in low- and middle-income countries and resource-limited health systems, to reach a larger proportion of patients in these countries.

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 2019, led to the methodology for the 2021 Access to Medicine Index.