Tracking progress of access strategies against patient reach goals

For equitable access to medicine to become a global reality, it is vital to determine whether companies’ healthcare products are actually reaching the people that need them most – specifically people living in low- and middle-income countries. Companies can monitor progress by establishing clear, measurable goals and targets, and defining methods to track patient reach and other outcomes. Then, the collected data can be used to tailor their strategies to suit country-specific needs, such as the healthcare system context and burdens of disease. This practice enables companies to more effectively address persistent access barriers and improve the success of strategies in reaching patients.

To determine how companies are tracking the outcomes of their access strategies, this iteration of the Index has placed a greater emphasis on assessing patient reach. Companies’ efforts to expand patient reach are analysed in both the Governance of Access (GA) and Product Delivery (PD) Technical Areas. As part of the assessment in GA, the Index determines whether companies have established processes to calculate eligible and target populations, as well as the number of patients reached. Within PD, the Index assesses whether and how companies report on the number of patients reached via their product- and country-specific access strategies. Two companies stand out for demonstrating best practice in both regards.

Best practice 

AstraZeneca and Novartis have established processes to calculate eligible and target populations, as well as the number of patients reached. Additionally, AstraZeneca and Novartis also report on the number of patients reached for most of the product- and country-specific access strategy examples analysed, with both companies demonstrating consistent efforts to monitor the outcomes of their access strategies included in the analysis across all three country income classifications: low-income (LIC), lower-middle income (LMIC) and upper-middle-income (UMIC).

For AstraZeneca, the Index analysed 25 country-specific access strategies for 10 products. Overall, AstraZeneca sets clear, product- and country-specific goals and discloses its plans on how to advance these strategies. It defines eligible and target populations, and reports related figures, for most strategies analysed. It also consistently reports patient reach approaches (based mainly on its sales and assumptions about product consumption, integrated with data from patient support programmes [PSPs] when implemented in a country strategy). AstraZeneca provides patient reach data for most strategies. In addition to sales and/or patients reached, the company reports on how it tracks overall progress by monitoring metrics, including access penetration, reimbursement in the public sector, and geographic reach. For almost half of the access strategies analysed, AstraZeneca reported an increase in the number of patients reached compared to the previous Index.

For example, for its oncology products, durvalumab (Imfinzi®) and osimertinib (Tagrisso®), the company reports on the progress of its access strategies in different countries. In Mexico (UMIC), where both products are reimbursed in the public system and PSPs are available in the private market, the company has reported a 97% and 60% increase in patients reached for durvalumab and osimertinib respectively, between 2022 and 2023, with plans to further expand access and reach. Increased reach during the same period has been reported for both products in Egypt (LMIC), where durvalumab is not yet publicly reimbursed, however, PSPs are offered for both products. AstraZeneca engages in health-system strengthening initiatives, which are monitored and reported as part of the strategy’s progress.

For Novartis, the Index assessed the outcomes of 17 country-specific access strategies across seven products. The company sets clear goals and plans for how to improve strategies, such as increasing reach through public reimbursement. It tailors goals and plans to suit context and includes health system strengthening targets in some strategies, indicating a comprehensive approach to access. It uses standardised methods to define eligible and target patient populations, as well as patient reach (based on volumes sold and treatment doses and duration). For all of Novartis’s strategies analysed (excluding one recent launch), the company reported patient reach numbers for 2023, as well as a growth percentage in patient reach compared to 2022. For example, for sacubitril/valsartan (Entresto®), indicated for ischaemic heart disease, the company has put comprehensive access strategies in place across countries of different income classifications (Mexico, Ethiopia and India) for years. It reported patient reach increases in 2023, demonstrating continued progress in reaching patients through access strategies.

Conclusion 

By establishing clear, measurable goals and targets, and defining methods to track patient reach and other outcomes, companies can monitor progress to improve the success of their strategies in reaching patients. Doing so enables them to more effectively address persistent access barriers, as they can improve and tailor their strategies to suit country-specific needs, such as the healthcare system context and burden of disease faced by different countries.

AstraZeneca and Novartis exemplify best practice in monitoring and reporting progress of their access strategies, including the number of patients reached with their products, and more companies are encouraged to do so. However, there is room for improvement; sales figures are the primary metric for tracking patient reach, but these numbers do not necessarily reflect success in reaching patients across the income pyramid. A broader perspective is needed to tailor metrics and assumptions, such as evidence of whether patients adhere to treatment, and to customise these measures for different product types, patient demographics, treatment modalities, and healthcare environments. As monitoring practices develop, the Index looks for companies to be transparent to help others adopt Best Practice.