Emerging markets as a growth opportunity for pharmaceutical companies

Characterised by rising incomes, expanding healthcare systems and growing populations, emerging markets are actively developing economies that are driving new demand for medicines. Combined with evolving regulatory frameworks and a rising burden of chronic disease, these factors create significant opportunities for pharmaceutical companies. Together, emerging markets already generate an average of approximately 23%^* of revenue for some of the 20 largest research-based pharmaceutical companies in scope of the 2024 Access to Medicine Index (the 2024 Index).

Ten countries are among the fastest-growing pharmaceutical markets in the world: Brazil, China, Colombia, Egypt, India, Indonesia, Mexico, South Africa, Thailand and Vietnam. Collectively, they are home to nearly half of the world’s population and accounted for approximately 18% of global medicine spending in 2024.^**,1 This highlights the scale of opportunity these markets offer for both commercial returns and improving access to medicines.

How companies operate in these countries reflects how effectively they are identifying and capturing growth opportunities beyond high-income settings. Robust activity signals a forward-looking strategy that leverages market potential while expanding local presence needed for long-term progress. By doing so, companies can diversify revenue streams, unlock new growth potential and contribute to public health outcomes.

To assess the landscape of company activity in these emerging markets, this analysis examines three areas: registration and supply of selected products and clinical trial activity within research and development (R&D) projects.

Scope of the analysis:

• This analysis is based on 2024 Access to Medicine Index data and involves 20 of the world’s largest research-based pharmaceutical companies, with a period of analysis from 1 June 2022 to 31 May 2024. Company activities may have evolved since the end of this timeframe. 

• The analysis does not include companies’ entire pipelines and portfolios. Instead, it focuses on a selected set of products targeting diseases, conditions and pathogens that disproportionately affect people in low- and middle-income countries (LMICs). 

• The set of products included for registration may differ from those for supply. 

• More information can be found in the Methodology for the 2024 Access to Medicine Index.

Bringing products to emerging markets 

Registering newly approved products and ensuring product supply in emerging markets signals company intentions and investments in these markets. While registration^*** indicates a company’s ambition to enter a market, supply signals market uptake and patient reach.  

Findings: 

• While the average achieved potential across the companies is 48% for registration and 61% for supply, four companies – AstraZeneca, Novartis, Novo Nordisk and Roche – stand out, achieving over 75% of their potential across both areas.   

• For registration, AstraZeneca, Bayer, Novartis, Novo Nordisk and Roche represent the top five companies together achieving an average of 81% of their registration potential for recently approved medicines across their selected product portfolios. 

• For supply, AstraZeneca, Boehringer Ingelheim, Novartis, Novo Nordisk and Roche represent the top five companies, achieving an average supply potential of 88%, based on their selected product portfolios. 

• Brazil received the most registration and supply efforts from companies, reflecting its position as one of the most established emerging markets and the largest pharmaceutical market in South America.  

• More than 50% of the recently approved products analysed were registered in Colombia and Thailand, both relatively less mature emerging markets, with Thailand also showing notable supply activity. This likely reflects improved regulatory capacity in recent years, as well as high health insurance coverage and low out-of-pocket spending in both countries. 

Investing in emerging markets for the future 

Running clinical trials in a country signals a company’s intention to register there in the future, as companies that test their products locally typically prioritise that country for future launches and market access. The scale and geographic diversity of this activity indicate where companies are focusing their future efforts.

Findings:

• Ten companies – AstraZeneca, GSK, Johnson & Johnson, Lilly, MSD, Novartis, Novo Nordisk, Pfizer, Roche and Takeda – included trial participants from at least one of the ten countries in more than half of their R&D pipeline projects.

• Most companies prioritised Brazil, China, Mexico and South Africa, where clinical trial capacity has expanded significantly over the past two decades. China stands out among emerging markets as it is included in 31% of companies’ R&D projects.

• Of the R&D projects conducted in emerging markets, China was also the only emerging market involved in at least half of the projects led by Boehringer Ingelheim, Daiichi Sankyo, Merck KGaA and Takeda, reflecting its mature research ecosystem and commercial attractiveness. 

• While Phase I clinical trials are typically conducted in high-income countries, 15 companies carried out at least one Phase I clinical trial in emerging markets, with China being the preferred location. 

• Some companies have extended their R&D activity beyond the larger, more established emerging markets. For example, AstraZeneca is active in Thailand and Vietnam, and MSD in Colombia where they have the highest number of R&D projects, building the foundation for a stronger future presence in these markets. 

AstraZeneca, Novartis, Novo Nordisk and Roche demonstrate the most consistent presence in emerging markets across registration, supply and pipeline projects. Additionally, Bayer demonstrates solid efforts in registration, Boehringer Ingelheim in supply, while GSK, Johnson & Johnson, Lilly, MSD, Pfizer and Takeda stand out for their notable pipeline footprint. However, these patterns are indicative rather than definitive as company efforts extend beyond the scope of this analysis. 

Market activity in these countries is growing, not just in more mature emerging markets such as Brazil, China, India and Mexico, but increasingly beyond them. Companies with a strong and broadening presence across emerging markets are well-positioned to diversify their revenue streams and strengthen their long-term commercial outlook in some of the world's most dynamic markets while improving their patient reach.

* These values were calculated based on companies’ 2023 financial statements. Reporting practices vary across companies, including differences in financial metrics (revenue, sales and net sales), as well as geographic aggregation. Where possible, the most disaggregated data were used to infer emerging markets representation per company.

** This value represents the global medicine spending of the IQVIA Pharmerging markets, which overlap almost completely with this review’s country selection.

*** The terms ‘registration’ and ‘registered’ indicate that a medicine has been filed for registration and/or has successfully been registered.

​​References

1. IQVIA. The Global Use of Medicines Outlook through 2029. 2025. www.iqviainstitute.org

​2. Eli Lilly and Company. A Study of Orforglipron (LY3502970) in Adult Participants With Type 2 Diabetes and Inadequate Glycemic Control With Diet and Exercise Alone (ACHIEVE-1). ClinicalTrials.gov identifier: NCT05971940. Accessed April 14, 2026. https://clinicaltrials.gov/study/NCT05971940 

​3. Novo Nordisk A/S. A Research Study to See How Well CagriSema Compared to Semaglutide, Cagrilintide and Placebo Lowers Blood Sugar and Body Weight in People With Type 2 Diabetes Treated With Metformin With or Without an SGLT2 Inhibitor (REIMAGINE 2). ClinicalTrials.gov identifier: NCT06065540. Accessed April 14, 2026. https://clinicaltrials.gov/study/NCT06065540