Pharma’s Patient Reach Problem: Billions Still Left Behind

The global pharma industry is facing increased pressure to ensure lifesaving medications reach underserved populations. Drawing from a new Access to Medicine Foundation report, AMF Head of Research Claudia Martinez shares some exclusive insights on where pharma has made significant strides on the important metric of ‘patient reach’ and the road still to travel.

Pharma has long engaged in access programs in low- and middle-income countries (LMICs), but these have not led to the outcomes that might have been hoped for. As Martinez points out, “Over 15 years’ worth of data on companies’ access strategies for LMICs shows that billions of people are still missing out, not only for cutting edge innovations, but also some of the most basic life-saving products. Discussions on health equity have therefore never been more important.”

Historically these programs have been piecemeal affairs; a mix between philanthropic giving and commercial programs that cover only certain parts of companies’ portfolios and only in certain countries or regions. Promisingly, in more recent years some of the world’s leading firms have started to launch dedicated comprehensive access programs that could signal a move away from one-off pilots and towards a more holistic approach to access and patient reach.

Many of these strategies come with eyebrow-raising patient reach commitments: Novo Nordisk’s iCARE program, for example, aims to cover 49 sub-Saharan African countries; Sanofi’s Global Health Unit represents 30 medicines in 40 countries; while Pfizer’s ‘Accord for a Healthier World’ aims to bring patented medicines to 45 of the world’s poorest countries.

However, while pharma companies have made ambitious commitments to expanding access, the impact remains uneven. “The potential for these strategies is huge, but we need to better understand how companies are planning to measure and track their progress and impact. Without this, potential just remains potential.”

The new AMF Patient Reach Report, released on September 10th 2024, investigates how well pharma companies are tracking the number of patients they reach through their access programs, particularly in LMICs. The findings, based on 42 different approaches across 19 companies, reveal a wide variation in the methods used to track patient reach. Some companies, including AstraZeneca, Novartis, and Roche, have developed more sophisticated frameworks that go beyond merely tracking sales data while others still have work to do.

“We hope to see the industry moving toward some commonly agreed principles in terms of how to measure patient reach,” says Martinez. “It’s not enough to measure patient reach for one product in one country alone; we need to see systematic application of whatever measurement approach you have, integrated into your overall business strategy.” Supporting this claim of fragmentation, only six of the companies surveyed – Astellas, AstraZeneca, MSD, Novartis, Pfizer, and one (undisclosed) other – have patient reach approaches that encompass all countries where they operate.

Moreover, while 19 out of the 20 companies assessed have reported approaches to track patient reach (AbbVie being the only outlier), there is little consensus on how to calculate these figures. As a result, gaps remain in understanding the number of patients reached in certain countries or for specific diseases, which complicates efforts to address unmet needs​.

One of the main challenges highlighted in the report is the lack of standardisation in how companies track patient reach. The fragmented nature of the data makes it difficult to get a clear picture of how many people are benefitting from these programs. “It’s early days for the industry,” Martinez admits. “We’ve seen good progress in some areas, but in many cases, companies still need to set clearer, more actionable goals to achieve a meaningful impact.”

The report also underscores the need for more precise commitments in high-burden but difficult-to-track noncommunicable diseases like diabetes. Martinez asserts that while insulin manufacturers Eli Lilly, Novo Nordisk, and Sanofi dominate the global market, their collective efforts address only one percent of the diabetes prevalence in LMICs. “It’s a market that is quite unique, with three companies dominating the supply. Yet, despite well-defined needs, we see that the goals these companies have set are not ambitious enough.”

There has, however, been significant progress made in infectious diseases and contraception, Martinez highlighting the work of J&J, Bayer, and GSK in these fields. “These are therapeutic areas with strong donor support as well as a lot of supranational procurement, perhaps making the setting of targeted patient reach goals more straightforward,” she suggests.

For pharmaceutical companies to truly make a difference, they need to embed patient reach at the heart of their business operations. As Martinez puts it, “Companies must prioritise patient reach or risk falling short in addressing health inequity. Our findings lay out a clear path for pharma companies to do this, emphasising how they can embed equitable access within their business operations.”

Martinez hopes that this new report will be a critical resource for stakeholders across the healthcare ecosystem looking to better understand how pharma companies are performing in this area, as well as a call to arms for the pharma industry to do more. Patient reach will be a key metric in the upcoming Access to Medicine Index 2024, which ranks global biopharma’s biggest players across a range of patient access indicators in LMICs. She notes, “The world is paying attention. [Patient reach] goals should be backed by clear rationales as to why they were set, how they will be achieved, and, importantly, progress must be publicly reported.”

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