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2012 Access to Medicines Index: What does it really index?

01 January 2013 Farah Ramadan

The 2012 Access to Medicine Index (AMI) results have recently been published with GlaxoSmithKline (GSK) securing the leader spot yet again followed by Johnson & Johnson (J&J) and Sanofi.

Access to Medicines Index (AMI)
The AMI was developed by the Access to Medicine Foundation, an international not-for-profit organisation dedicated to improving access to medicines in societies in need. The AMI was first measured in 2008 and then again in 2010 and 2012.

The index assesses companies' efforts in increasing access to drugs in developing countries looking at seven areas and evaluating companies in each activity to assign a score comparable across firms. The seven strategic areas studied include medicine management, public policy, research and development, equitable pricing, patents, capacity building, as well as donations and philanthropy.

Examples of AMI findings
I recently had the opportunity to review the AMI report in detail while working on a study we recently published entitled 'Payer-industry partnerships in emerging markets: best practices for successful market access of new pharmaceuticals.' For this study I explored partnerships between International Health Organisations (IHOs) and pharmaceutical companies. One finding from the AMI report that corroborated my own research is that both generics and originators companies engage in partnerships with IHOs to strengthen access to medicines in developing countries, however with different focus following their structural functions and capabilities. For example, big pharma is more engaged in intellectual property and compound libraries sharing type of partnerships while generics companies focus on activities for capacity building in developing countries.

However, while doing research for our study, I uncovered that not all access to medicine initiatives are effective. For example, tiered-pricing schemes are being used to enhance medicines' affordability in developing countries, however not without ambiguity to the extent of reduced prices offered in different countries. There is not a clear methodology as to how the price discounts are being calculated at the moment. Also, there is no guarantee that discounted medicines are reaching patients in need and not redirected to the developed markets as there is no tracking system.

Beyond Access to Medicines Index
The AMI is the first index to measure and rank pharmaceutical companies' activities towards access to medicine in developing countries, an area of increased commitment for the Industry. In fact, access to medicines programmes in developing countries is figuring prominently on corporate websites as illustrated by those of this year's AMI top-ranking companies.

There is no doubt that pharmaceutical companies strengthened their efforts to increase access to medicines in developing countries and achieve health for all. Access to medicine is slowly moving away from just a philanthropic effort to a strategic plan assumed by drug manufacturers. Companies have gone in different ways in achieving this goal, with a number of innovative strategies ranging from adaptive R&D, tiered pricing strategies, capacity building activities to non-exclusive voluntary licences. The work of the Access to Medicines Foundation is a step forward in measuring access to medicines and encouraging industry's transparency with that regards. However, I believe that a quantitative approach would be more insightful in measuring the actual impact of the various programmes on access to medicines. These measures could include the extent to which these programmes:

  • increase the number of lives saved,
  • reduce infant mortality rates,
  • increase proportion of 1 year-old children immunised against measles,
  • increase proportion of births attended by skilled health personnel or
  • decrease incidence and death rates associated with malaria

These metrics are only examples for quantitative measurement and I would like to see metrics of the sort factored in the AMI to measure the effectiveness of the initiatives on access to medicines. Engaging in activities and partnerships to increase access to medicines does by no means guarantee success as I concluded while doing research for our study. On the upside, there are a number of recommendations and best practices that pharmaceutical companies can apply in developing markets to increase access to their medicines and build relationships with payers to promote market access in the longer term.

Posted 1 January 2013

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