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.
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
The access barriers facing HCP-products
Healthcare practitioner-administered (HCP-administered) products are 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 and antibiotics. Significant barriers to access to the HCP-administered products can be linked to gaps in local healthcare infrastructure — particularly in low- and middle-income countries — with pharmaceutical companies acknowledging that access to these medicines is at times dependent on healthcare settings.
Seventeen companies in scope have HCP-administered products in their portfolio. A total sample of 60 products was assessed.* 76% of these products target NCDs, mostly cancer, and only 10% products target maternal and neonatal health conditions including intrauterine contraceptive device (IUDs) and medicines for pre-term birth complications or maternal haemorrhage.
What the Index measured
The Index assessed whether companies factor in the ability to pay from both the public sector (i.e., national authorities and public insurance) and private sector (private insurance and ‘out of pocket market’), whether they take additional steps to maximise the patient reach through, for example, voluntary discounts to reduce co-pay, patient assistance programmes, product donations and whether the strategy increases patient reach. For each product, the company was asked to provide examples of access strategies for one upper-middle-income country (UMIC), one lower-middle-income country (LMIC) and one low-income country (LIC).
Low coverage across HCP-products
Currently, only 8 out of 60 (13%) critical products that need to be administered by HCPs – including, for example, injectable treatments for cancer – are covered by access strategies in at least one LIC. In LMICs, this number jumps to 25 out of 60 (42%) for HCP-administered products. Further up the income ladder, the picture is better, with approximately half of products covered by an access strategy in at least one upper middle income country (UMIC). Worryingly, however, 28 out of 60 (47%) of the HCP-administered products did not have evidence of access strategies in any of 106 countries in scope.
Considering people’s ability to pay for HCP-administered products
The Index expects companies to have access strategies in place that cover all patients in the countries assessed, independently of the channel by which they access the product. To that end, the Index looked at whether companies consider ability to pay in either public or private sector or both.
In UMICs, when companies have an access strategy, they consider ability to pay in the public sector in almost all instances, whereas in the private sector, ability to pay is considered in only half of the access strategies. This is because public sectors in UMICs are likely more developed and better structured than in LMICs and LICs. China (UMIC) is an example of a country where once the product is included on the National Reimbursed Drugs List, it becomes almost exclusively paid for by the public authorities. In LICs, when companies have an access strategy, they consider ability to pay in the public sector for all products. They also consider ability to pay in the private sector for six of the eight products. If there is no reimbursement for the two products where only ability to pay in the public sector, they would likely not be available for the private sector.
Novartis is the only company in scope that ensures that an equitable strategy is in place in LICs for all products.
Are access strategies for HCP-products reaching patients in need?
The Index also looked for evidence of patient reach as a result of companies’ access strategies. For almost all the products where the Index assessed that the companies applied an access strategy in a particular country, evidence of patient reach was provided. However, an apparent increase in patient reach was demonstrated by eight companies for only a handful of products (11 out of 28 in UMICs, 10 out of 25 in LMICs and one out of eight in LICs).
Example of patient reach for HCP-products ranges for a few disease areas:
- For oncology treatments the reach ranges from less than 100 patients in some countries to more than 31,000 in a UMIC.
- For asthma treatments the reach ranges from approximately 100 patients in some countries to 10,000 in a UMIC.
- For ischaemic heart disease and stroke treatment the reach range approximately from less than 100 patients in one LMIC to 238,000 in a UMIC.
Are companies taking steps to overcome gaps in health systems to increase access to these products?
The products assessed in this category, require ‘extra capacity’ (i.e., specialised care) to be administered. Some health systems in countries in scope lack such capacity and are not ready to absorb innovative products which might deter companies from entering the market. This, however, can be an opportunity for companies to engage in capacity building initiatives, as they often have the know-how, resources and strategic incentives to help fill these gaps.
To increase access, 11 companies (Astellas, AstraZeneca, Boehringer Ingelheim, Eisai, GSK, Johnson & Johnson, Novartis, Pfizer, Roche, Sanofi and Takeda) report taking steps to help strengthen healthcare systems such as building diagnostics capacity or training healthcare professionals. A stand-out example includes
Takeda's initiative to support the safe administration of the oncology treatment leuprolide acetate (Lupron®) in Rwanda. The initiative is aimed at training healthcare workers on integrated cancer control and management; enhancing the quality of screening, diagnostic services; ensuring adequate stock of equipment and consumables; and expanding of Telemedicine and Telepathology services at all referral hospitals in Rwanda.
People living in lower-income countries are overlooked
While the Index sees some good examples of access strategies, patients in low-income countries are still being overlooked. To address the challenge of affordability more efficiently, companies should look at implementing price reductions or price segmentation (such as second brand approach or patient assistance programmes) in more countries, especially in LICs.
In most of the strategies for the HCP-administered products assessed by the Index, the patient reach reported in countries does not match the disease burden and several companies are still not transparent in reporting numbers. When companies address affordability, they should start where the need is the biggest. Companies should also be transparent on numbers of patients reached in order for access gaps to be identified and filled.
Please note: For this analysis, the Index analysed a sample of the companies’ portfolio products, looking at a maximum of five products per company.
* A product can target multiple diseases corresponding to multiple disease areas.
