Tailoring pricing strategies according to the ability of countries and individuals to pay

Novartis uses additional layers of strategy to increase patient reach. To address affordability in low- and middle-income countries, the company has launched emerging market brands (EMBs), which are generally priced significantly lower than the original brands. Novartis continues to lead by tailoring its strategies for several products in countries in different income classifications (upper-middle income, lower-middle income and low-income). Here, the Index highlights the company's approach for three products.

Regarding Novartis’s heart failure treatment sacubitril/valsartan (Entresto®), all three examples submitted by the company for analysis in the 2022 Index are high-quality strategies that address affordability. In Mexico, working with the main national institutional payers, including the largest Latin American health payer IMSS, it has expanded access to hospitals with different specialities and types of services, and increased patient reach more than a hundredfold. In India’s self-pay private market, it launched an EMB and has partnered with two local companies (Lupin and Cipla) to expand access and launch co-marketed local EMBs (Azmarda and Cidmus). India now has three brands of the same product at three prices: Novartis’s Vymada sacubitril/valsartan (Entresto®) EMB has reached 250,000 patients while Azmarda and Cidmus have (between them) been used to reach an additional 92,000 people. In Ethiopia, the company has applied additional flexibility on price for its EMB (Uperio) to patients paying out-of-pocket in the private sector.

Novartis has strong access strategies for ribociclib (Kisqali®), a medicine to treat breast cancer. For example, it demonstrates best practice in South Africa, using a novel combination to increase access: it has launched an EMB branded as Kryxana (available for 20% less than the private price for hospitals on a buy-out basis) and offers financial assistance via the Access to Innovative Care Foundation by covering up to 25% of co-payment costs for patients paying out of pocket or via insurance. This solution bridges a gap while Novartis works with public health bodies and practitioners to get ribociclib included in standard treatment guidelines. In India, it applies an innovative strategy to supply this via an EMB for the private market, reducing price and capping payment for patients during treatment. Novartis will launch ribociclib (Kryxana) in low-income African countries including Ethiopia, Rwanda and Uganda in 2023, and is working closely on this with ministries of health and the Clinton Health Access Initiative (CHAI).

For erenumab (Aimovig®), which treats migraine, the company uses a strategy in Thailand that keeps pricing flat across doses and provides certain doses to patients free of charge in the period of analysis, patient reach increased from 213 to 260. In Egypt, where patient reach has grown from 164 to 272, Novartis uses equitable pricing and offers the same price in private and public markets. It also has a support programme for patients paying out of pocket and with low-premium insurance, and a micro-finance scheme. In Ethiopia, the EMB brand Pasurta will soon be launched at a price lower than the global originator. Novartis expects 50 patients will receive treatment in 2022, with reach growing to around 500 by 2026.

Next steps

Novartis stands out for its creative approach to maximising patient reach. As well as applying tiered pricing strategies for several products, it uses EMBs and other non-pricing initiatives such as payment caps, microfinance and patient assistance programmes. It could now tailor these programmes further and consider using questionnaires and assessment by third-party vendors. Novartis could also provide more data on how it updates information about all relevant payers’ ability to pay and could disclose how it will keep prices affordable in a climate of rising inflation and production costs.