Access to Medicines Index 2018

Access to Medicines Index 2018
Access to Medicine Foundation. November 2018 :: 258 pages
Funders: UK Department for International Development; The Dutch Ministry of Foreign Affairs;
Bill & Melinda Gates Foundation

Executive Summary
Globally, two billion people cannot access the medicines they need, with millions in low- and middle-income countries dying each year from diseases because the vaccines, medicines and diagnostic tests that they need are either unavailable or unaffordable. Pharmaceutical companies control products that can greatly alleviate disease burdens; they also have the expertise to meet the need for new and adapted innovative products; the power to address the affordability of those products through more refined access strategies; and the ability to strengthen supply chains and support healthcare infrastructures. Considering their size, resources, pipelines, portfolios and global reach, these companies have a critical role to play in improving access to medicine.

For more than a decade, the Access to Medicine Foundation has worked to stimulate change within pharmaceutical companies. Every two years, it publishes its Access to Medicine Index, which analyses the top 20 research-based pharmaceutical companies and ranks them according to their efforts to improve access to medicine in developing countries. A total of 69 indicators make up a framework within which company performances relating to 77 diseases, conditions and pathogens in 106 low- and middle-income countries can be compared.

The Index analysis brings out best practices and examples, highlights areas where progress has been made and areas where critical action is required. The Index also acts as a benchmark where companies can compare their own contributions to improving access to medicine with their peers. While companies are held to a single standard, they are different in the way they operate and in their portfolio of investigational and marketed products. The Index is a relative ranking: scores cannot be directly compared between Indices.

The methodology is updated every two years in line with developments in access to medicine
following a wide-ranging multi-stakeholder dialogue. For the first time this year, the Index examines company efforts to increase access to cancer products. Also for the first time, the Index zeroes in on 53 products on the market that it considers particularly critical candidates for company access initiatives and evaluates what companies are doing to facilitate their affordability and supply. These are products that are on patent, first-line therapies and on the World Health Organization Model List of Essential Medicines (EML).

This report outlines the key findings and overall ranking analysis of the 2018 Access to Medicine
Index before presenting a detailed analysis of company performances and rankings in each of the seven areas of corporate activity it focuses on. The report concludes with detailed, tailored company report cards that explain each company’ performance, highlight industry-leading practices and company-specific opportunities to improve access to medicine.

:: Most priority R&D projects are being conducted by five companies: GSK, Johnson & Johnson, Merck KGaA, Novartis and Sanofi. Such concentration is also seen in the industry’s overwhelming focus on five of the 45 priority diseases – malaria, HIV/AIDS, tuberculosis, Chagas disease and leishmaniasis– targeting that reflects international donor priorities.

:: Access initiatives for cancer focus on pricing but have limited reach, mainly for small population groups and fewer than five key countries on average. Meanwhile, access planning for cancer products in the pipeline lags far behind that for communicable disease candidate products and plans are less comprehensive.

:: The majority of the 53 key on-patent products have an access initiative attached to them, but these are limited in scope, with pricing schemes being applied in fewer than five countries where greater affordability is a priority. Many of these key products with access initiatives are for diseases prioritised by global health donors or international procurers.