Big Pharma is usually seen as the villain in the healthcare story, often perceived as putting profits before patients.

But an initiative by the Netherlands-based Access to Medicine Foundation, an independent non-profit organisation, is pushing the pharma big daddies to compete and collaborate on improving access to medicines. And the Foundation does this through the Access to Medicine Index, a biennial report that assesses companies on seven criteria in corporate behaviour including pricing, patents, ethics and donations.

In its fifth report since inception, the Index puts GlaxoSmithKline at the top, for the fifth time, as it emerged the best in matching access activities with patient needs, the Index report said. Close on its heels came Johnson & Johnson, Novartis and Merck KGaA.

These companies fared well because they had the most mature access programmes, with well-organised strategies that support business development in emerging markets, where the need for access to medicine is high, the Index report says.

Explaining the dissonance between the negative perception of Big Pharma with the positives the Index lists, Foundation Executive Director Jayasree K Iyer agrees that Big Pharma does have a terrible reputation in terms of pricing, access, etc. But the Foundation looks to shine a light on good practices to get companies to compete in pushing their access, innovation and ethical programmes, explains Iyer. Innovator companies are researching medicines for neglected diseases, she says, and the aim is to balance stakeholder and shareholder expectations.

Even as the Index looks to rate good ideas that change peoples lives and the magnitude of such an activity, Jayasree observes that companies are nowhere close to what is required. The report finds that while companies are doing better in terms of handling their patents and allowing other manufacturers to make generic versions of their drug to expand access and reduce prices, the newest products are registered in only 25 per cent of countries that the Foundation identifies as high priority. And the “need-based” pricing strategy is extended to only 5 per cent of relevant products (or 44 of 850 products).

The report covers 20 top innovator companies, with 850 products for the 51 most burdensome diseases in low- and middle-income countries, with another 420 under development. The report does not include oncology because it was felt that cancer could divert the attention from the actual intent of the Index. And if anything, needed a report solely focused on oncology.

Investment guide

Jayasree explains that the Index works as a guide for the investment community advising people looking for companies with good environmental, social and governance practices, besides the traditional financial risks and opportunities. Sixty investors who manage assets over $5.5 trillion are signed up on a list supporting a tool like the Access Index to assess drug companies.

Drug companies are able to understand what is expected of them and governments can use it to understand what they can demand from these companies for their citizens, she adds.

The Foundation is funded by the British Government (UK AID), the Dutch Ministry of Foreign Affairs, and the Bill & Melinda Gates Foundation.

Index insights

Improving its rating on the Index are AstraZeneca and Takeda, having “extensively expanded and updated their access strategies”. AstraZeneca climbed eight positions into the top 10 to 7, and Takeda moved up five places to 15.

But Novo Nordisk, Roche and Gilead dropped in ranking, outperformed by peers. There is a lot more these companies can do, says Jayasree, specially since it is a competitive index and their peers are proactive.

Interestingly, on compliance and ethical marketing, Gilead, Novo Nordisk and Eisai top the charts, while GSK and Novartis take a hit for the breach of the marketing code in China.

On the anvil are report cards for generic drug-makers (including Indian companies) and vaccines, besides an Anti-Microbial Benchmark (as antibiotic resistance becomes a global concern). And as the Access to Medicine Index shows, peer pressure could well be a key motivator in pushing drug companies to see a business rationale in pursuing improved access-to-medicine strategies.

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