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.
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
Self-administered products and LMICs
Self-administered products are defined as those products which are easier to be administered by the individual patient. Such products are particularly useful in low- and middle-income countries (LMICs) and resource-limited health systems. Self-administered products are not necessarily prioritised by governments (typically, treatments for other non-communicable diseases (NCDs), such as diabetes, stroke, hypertension and heart disease).
All 20 companies in scope have self-administered products in their portfolio. A total sample of 94 products was assessed. Most of these products target NCDs (78 out of 94). Of these, 28% (22 out of 78) are self-administered oncology products.
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 products
Only 24 out of 94 (26%) products are covered by access strategies in at least one LIC. This figure jumps to 40 out of 94 (43%) in LMICs. Similar to HCP-administered products, approximately half of products are covered by an access strategy in at least UMIC. However, 36 out of 94 (38%) self-administered products analysed did not have evidence of access strategies in any of 106 countries in scope.
Considering people’s ability to pay for self-administered products
When looking at access strategies the Index assessed whether companies consider people’s ability to pay into account. In general, access strategies for self-administered products that take into account ability to pay are more often found in private settings when compared with HCPs products.
In UMICs, when companies have an access strategy, they consider ability to pay in the public sector in almost all instances and ability to pay in the private sector in half of the access strategies. In both LMICs and LICs the Index sees more access strategies where companies consider only the private sector. This can be attributed to the multiple factors such as weaker public sectors and prioritisation of the wealthy population in those countries.
Are access strategies reaching patients in need?
The Index also looked for evidence of patient reach as a result of companies’ access strategies for self-administered products. An apparent increase in patient reach was demonstrated by ten companies for only a handful of products.
Example of patient reach ranges for a few disease areas for self-administered products:
- For treatments for diabetes mellitus, the reach ranges from less than 100 patients in some LICs to approximately 1.65 million in a LMIC.
- For asthma treatments, the reach ranges from under a thousand patients in a LICs to approximately 800,000 in an UMIC and a LMIC.
- For treatment for hypertensive heart disease, the reach ranges from under 1,000 patients in an LMIC to approximately 70,000 patients in a UMIC.
People living in lower-income countries are overlooked
While the Index sees some good examples of access strategies for self-administered products, 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 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.
The good practices shown in this analysis indicate that some companies are stepping up their access mindset, e.g. Novartis, expanding their focus beyond lower middle-income countries and upper middle-income countries. Pfizer also stands out for targeting multiple countries across the income pyramid with their access strategies for self-administered products.
Please note: For this analysis, the Index analysed a sample of the companies’ portfolio products, looking at a maximum of five products per company.