Implementing strong access strategies across different country income classifications

GSK, Pfizer and Takeda demonstrate best practice by addressing accessibility and affordability in their access strategies, showing evidence of tailoring their access strategies to meet the needs of countries in different income brackets.

GSK (via its majority-owned business specialising in HIV products, ViiV Healthcare), demonstrates a comprehensive approach to expanding access to its HIV product abacavir, dolutegravir and lamivudine (ALD) (Triumeq®). Its access strategies include tailored equitable pricing strategies, voluntary licensing accompanied by technology transfers, and health systems strengthening initiatives.

In Colombia (an upper-middle income country) and India (a lower-middle income country), ViiV Healthcare commits to applying a flexible pricing approach that factors in gross national income and public health need. Prices are then refined based on local affordability, domestic healthcare system funding, purchasing patterns and volumes, and accessibility for those living with HIV/AIDS. In Uganda (a low-income country), ViiV Healthcare provides extensive support for health system strengthening activities through its Positive Action programme. ViiV Healthcare uses voluntary licences, enabling generic medicine manufacturers to develop, manufacture and market dolutegravir and dolutegravir-based fixed dose combinations, including ALD. For example, ViiV Healthcare does not currently supply abacavir, dolutegravir and lamivudine (ALD) in India, but partners with two India-based generic medicine manufacturers (Mylan Laboratories Ltd and Aurobindo Pharma) that hold voluntary licences to expedite development of more affordable paediatric dispersible formulations of ALD.

Pfizer uses high-quality access strategies to expand access to palbociclib (Ibrance®), used to treat breast cancer. In Mexico (an upper-middle income country), compared to the previous Index, Pfizer has increased patient reach by continuing with strategies including tiered discounts in the private market, based on co-payment. In India (a lower-middle income country), in 2021 Pfizer introduced a differential approach in a new patient assistance programme, using questionnaires and independent evaluation to assess affordability. In Uganda (a low-income country), its compassionate use programme allows it to make the product available to patients before the product has entered the market.

Takeda was recognised in the 2021 Index for its access strategy for its non-Hodgkin's lymphoma treatment brentuximab vedotin (Adcetris®) in Thailand (an upper-middle income country). Takeda provides evidence of growth in patient reach and uses a third-party organisation to provide data that enables it to tailor prices for individual patients. In the Philippines (a lower-middle income country), where it maintains a patient assistance programme (PAP), it also works with the government to secure funding for medicines and support for diagnostic testing. In addition, it has collaborated with the Philippine Cancer Society to provide financial aid to patients. In Rwanda (a low-income country), once the product is registered, it plans to use inter-country pricing, a PAP and a third-party organisation for evaluative data. Here, it demonstrates best practice by providing patient forecasts to help anticipate demand for the product.

Next steps

The best comprehensive access strategies reflect the needs of a particular country for a specific product. Differentiation is key to increasing affordability, and companies should seek to understand all barriers to access and in each case allow tailoring for affordability. GSK stands out in this area. Pfizer and Takeda deserve credit for increasing patient reach since the last Index. Other companies have yet to follow suit, and all three that lead still have room to improve. All companies should look to apply comprehensive high-quality strategies with consistency, increasing patient reach and widening both their geographic and product scope.