What is the Access to Medicine Index? 
The Access to Medicine Index ranks 20 of the world's largest research-based pharmaceutical companies in how they improve access to medicine, vaccines and diagnostics in low- to middle-income countries. It has been published every two years since 2008. It is independently funded, currently by the UK and Dutch governments, the Bill & Melinda Gates Foundation, Wellcome Trust and AXA Investment Managers.

Who makes the Access to Medicine Index? 
The Index is produced and published by the Access to Medicine Foundation, an international non-profit organisation. The Foundation's mission is to stimulate and guide pharmaceutical companies to do more for people living in low- and middle-income countries without access to medicine. The Foundation has published the Access to Medicine Index every two years since 2008. It published its Access to Vaccines Index in 2017, followed by the latest Antimicrobial Resistance Benchmark in January 2020.

What is the aim of the Access to Medicine Index? How does it change pharmaceutical companies? 
The Index is a tool for driving change in the pharmaceutical industry. It identifies best practice, tracks progress and shows where critical action is needed to improve access to medicine for the poor. It provides companies and other stakeholders with a transparent means by which they can assess, monitor and improve companies’ performances in practice, as well as their public and investment profiles.

Why does the Access to Medicine Index focus on pharmaceutical companies?  
Considering their size, resources, pipelines, portfolios and global reach, large pharmaceutical companies have a critical role to play in improving access to medicine. The Access to Medicine Index was established with two aims: first to define a clear list of what pharmaceutical companies can and should be doing to improve access; and second to spur companies to compete to perform best against this list of expectations. Before the Index, there was no clear path for pharmaceutical companies to follow in improving access to medicine. The 20 companies in the Access to Medicine Index account for around 70% of global pharmaceutical revenues. 

Are pharmaceutical companies solely responsible for addressing access to medicine? 
The access to medicine challenge is multi-faceted and many different actors must take responsibility. This includes the scientific research community, local governments, public health and regulatory agencies, overseas development agencies, philanthropists, trade administrators, the non-profit sector including product development partnerships, and both the research-based pharmaceutical companies and manufacturers of generic medicines. Pharmaceutical companies, with the resources and the knowledge to develop medicines, have a responsibility to ensure these technologies are made available to people, regardless of their socioeconomic standing. Improving access to medicine creates new routes to market, opening up demand for new and adapted products. As companies enter new markets, they must do so ethically and responsibly.

What does the 2021 Access to Medicine Index measure?  
The 2021 Access to Medicine Index uses an analytical framework of 33 indicators to capture and compare how 20 large R&D-based pharmaceutical companies perform on access in 106 low-and middle-income countries and for 82 diseases, conditions and pathogens identified as the most critical priorities regarding access to medicine. These include infectious diseases such as HIV/AIDs, malaria and tuberculosis, and emerging infectious diseases such as those caused by coronaviruses and Zika, as well as non-communicable diseases such as diabetes, epilepsy, chronic obstructive pulmonary disorder (COPD) and heart disease. The framework is constructed along three areas of focus, which cover the range of company activities that experts consider most relevant to access to medicine: governance, R&D and product delivery.

How were the 20 companies selected? 
The Access to Medicine Index analyses 20 of the world’s largest research-based pharmaceutical companies. They are selected based on their size, market capitalisation and the relevance of their product portfolio and pipeline. 

How was the data collected and verified?  
To make the Access to Medicine Index, the Foundation's research team analyses data from public sources and collected via a detailed survey of pharmaceutical companies regarding their policies and practices on access to medicine. Sources include the US FDA, the European Medicines Agency, Health Canada, ClinicalTrials.gov, MedsPal, LexisNexis, annual filings and reports from companies, among others. Data submitted by companies is verified, cross-checked and clarified by the research team using public sources and supporting documentation provided by the companies.

Does the data reflect a set time period?  
The 2021 Index includes relevant data from 1 June 2018 to 31 May 2020.   

Who conducted the analysis? 
The data-collection, analysis and scoring was completed in-house by a dedicated research team. The Research Programme Manager for the Index is James Hazel. Key sections of the report were submitted by the Foundation for peer reviews by independent experts, including members of the Expert Review Committee (ERC) for the Index. The report was also reviewed by the Chair of the ERC.

How was the methodology for the Index developed?  
The 2021 Index is the product of a rigorous methodology that is aligned every two years with new developments in access to medicine. The review for the 2021 Index began in 2019 and included a series of internal checks on indicators, data sets and analytical approaches. For 2021, the Foundation carried out a broader range of consultations than for previous iterations of the Access to Medicine Index, engaging with more than 100 experts and organisations. The resulting consensus was translated into a new analytical framework for capturing how far the world’s largest pharmaceutical companies are meeting society’s expectations on access to medicine. This forms the analytical basis for the next Access to Medicine Index. The analytical framework for 2021 has a tightened structure and sharper analytical capacity. The 33 indicators, grouped in three Technical Areas, reflect the core priorities for pharma company action.

How can my organisation contribute to the methodology development of the next Access to Medicine Index? 
Every two years, we carry out a targeted review of how stakeholders view pharma’s role in access to medicine. We engage with specialists from multilateral organisations, governments, research institutions, the pharma industry, NGOs, patient organisations and investors. These activities follow set timelines. If you would like to contribute, please get in touch.

Can you compare the 2021 Index to previous Indices? 
The Index is a relative ranking, where companies are compared with each other rather than against an absolute, ideal state. As a result, a direct longitudinal analysis, indicator by indicator, is not possible. This is due to changes over time in the data collected and the methods used to either verify, compare or otherwise analyse them. In our reporting, where we make a statement about change over time, we conduct specific analyses of the original data to ensure a comparison is possible. 

How is the Index funded?  
The 2021 Access to Medicine Index has been independently developed by the Access to Medicine Foundation, using funding by UK Foreign, Commonwealth, and Development Office, the Dutch Ministry of Foreign Affairs, Bill & Melinda Gates Foundation, Wellcome Trust and AXA Investment Managers. The Foundation is an independent non-profit organisation. 

Why is access to medicine a global issue?
The UN has estimated that two billion people worldwide lack access to diagnostics, vaccines and treatments because they are unaffordable, unaccessible or unavailable in their country. The constitution of the World Health Organization asserts that all people have the right to the highest attainable standard of health.

Which companies take the top spots in the 2021 ranking and why?
The top two companies, GSK followed by Novartis, are in close competition and are leading performers across the three main areas of measurement. For example, they implement equitable access strategies for the majority of products analysed, taking patients’ ability to pay into account, and providing evidence that additional patients were reached through their access strategies. They continue to address local access barriers through capacity building initiatives, while evaluating the outcomes of their activities. GSK has the largest pipeline of projects targeting established R&D priorities (81) and of late-stage projects covered by access plans (20/25). Novartis stands out for being the only company to apply equitable access strategies in at least one low-income country for all products assessed, as well as for implementing scalable and inclusive business models. 

How many Best Practices were identified in the 2021 Index?
The Access to Medicine Index seeks best practices in each of the areas it measures. Once identified, these are shared to accelerate their uptake by other pharmaceutical companies, to help raise the level of standard practice and to achieve greater access to medicine. The 2021 Index identified 23 best practices from 15 companies: four in Governance of Access, five in Research & Development and 14 in Product Delivery.

How did the 2021 Index cover COVID-19? 
The 2021 Index captured how pharmaceutical companies response to COVID-19, not only when it comes to pandemic preparedness but also in safeguarding their access-to-medicine programmes more broadly. In the 2021 Index:

• Pharma’s response to COVID-19: Exploration of companies' different responses to the 2020 pandemic, including case studies in, for example, medicines and vaccines R&D, efforts to pool and/or scale up manufacturing capacities, fair pricing actions, licenses to enable generic versions to enter the market, emergency relief donations programmes and capacity building initiatives. 
• Trend and progress analysis: Whether pharmaceutical companies are changing how they respond to global health priorities and to provide the broader context to the response to COVID-19. 
• Tailoring of access strategies: How pharmaceutical companies are tailoring their pricing, licensing and donations actions to specific market conditions, backed up with examples of best practice and analysis. 

Since 2018, are companies making progress to improve access to medicine
Although the methodology has been updated with a new robust framework since 2018, comparisons have been drawn in the three core technical areas (Governance of Access, Research and Development and Product Delivery) assessed by the Index to drive action in the industry:

• In the last 12 years the number of companies developing inclusive business models (IBM) has increased from 6 to 12, showing that companies are more willing to expand access to their health products for patients at the base of the income pyramid.
• Since 2018, the number of R&D projects targeting priority diseases as set by the global health community has increased from 38% to 66%.
• The number of companies engaging in donation programmes for neglected tropical diseases (NTD) as well as the number of structured programmes have increased in the last 12 years.
• Since 2014 the number of companies disclosing at least some information on the patent status of their products have constantly been increasing.
• The use of non-exclusive voluntary licensing remains confined to a small group of companies and diseases.
• There has been progress the uptake of health system strengthening, supply and R&D capacity building initiatives, but capacity building initiatives for manufacturing lags behind. 

The Frequently Asked Questions mentioned below refer to the 10-year analysis "Are pharmaceutical companies making progress when it comes to global health?"    

What is the “10-year analysis”?
The 10-year analysis “Are pharmaceutical companies making progress when it comes to global health?” is the first independent report that shows where pharmaceutical companies have made progress in the past ten years when it comes to access to medicine. It covers 20 of the world’s largest research-based pharmaceutical companies, which the Access to Medicine Foundation has tracked since 2008 in the Access to Medicine Index.

When was the 10-year analysis published? 
The report was published on Thursday 16 May, 2019 on the website of the Access to Medicine Foundation. 

What is the scope of this report?
The 10-year analysis covers: (a) areas where pharmaceutical companies have a clear role and responsibility to act; and (b) where action by pharmaceutical companies is critical for improving access to medicine. This includes research and development (R&D), as well as pricing, licensing and registering products for sale in countries in need. Its findings cover 106 low- and middle-income countries – home to 83% of all people alive today – and the 47 diseases and conditions that have been consistently covered by the Index since 2014. Each analysis goes back as far as data permit, with 2008 as the earliest possible year.

Which companies are covered in this report?
The 10-year analysis covers 20 of the world’s largest research-based pharmaceutical companies, which together account for 70% of global pharmaceutical revenues. They include highly diversified companies, such as GSK, Pfizer, Novartis and Sanofi, which all have large generics divisions. Several companies with a narrower focus, such as Gilead and Novo Nordisk, are also included in the cohort. These companies have been tracked in the Access to Medicine Index since 2008.  

All companies covered in the analysis: AbbVie Inc., Astellas Pharma Inc., AstraZeneca plc, Bayer AG, Boehringer Ingelheim GmbH, Bristol Myers Squibb Co, Daiichi Sankyo Co, Ltd, Eisai Co, Ltd, Eli Lilly & Co, Gilead Sciences Inc, GlaxoSmithKline plc, Johnson & Johnson, Merck & Co, Inc (MSD), Merck KgaA (Merck), Novartis AG, Novo Nordisk A/S, Pfizer Inc, Roche Holding AG, Sanofi and Takeda Pharmaceutical Co, Ltd.

Does the report assess how individual companies have progressed over time?  No – it assesses the level of progress across the industry in order to spark discussions about system-level improvements that can be made. The 2021 Access to Medicine Index covers changes per company since the previous Index and identifies specific opportunities for change company by company.

What were the sources of this report?   The data for this report have been independently collected and analysed by the Access to Medicine Foundation. Much of the data were gathered for the Access to Medicine Index, which has been published every two years since 2008. The specifics of the methodology used for the report are covered in the Appendix.

How can this report be used, for example by pharmaceutical companies?  The 10-year analysis looks ahead to 2030 and the achievement of SDG 3 to explore how the pharmaceutical industry can sustain and build on the progress made to date. Individual companies and coalitions can use the findings of this report to prepare for the next decade, for example, by taking stock of what has been achieved over the past decade in order to refine their approach, learn from best practice and scale up good practice to more products, countries and people.  

I would like to comment on the report. How can I best do this?  The report aims to provide a springboard for discussions on how the progress to date on access to medicine can be expanded across the industry in order to achieve SDG 3 by 2030. Please send any comments you have about this report to jhazel@accesstomedicinefoundation.org.