Low- and middle-income countries (LMICs), defined by the World Bank as having a gross national income (GNI) of below $13,995, are home to nearly 80% of the global population. Noncommunicable diseases (NCDs) disproportionately affect people in LMICs, with more than three-quarters (31.4 million) of global deaths related to NCDs occurring in LMICs. The life expectancy of someone living in a low-income country is around 18 years shorter than someone in a high-income country. [1, 2]
Essential medicines are defined by the World Health Organisation (WHO) as “those that effectively and safely treat the priority healthcare needs of the population. They are selected by taking into consideration public health relevance, evidence of benefits and harms, and with consideration of costs, affordability and other relevant factors.” Around a third of the world’s population lacks access to essential medicines that have potential to save millions of lives. Improving access to essential medicines can also reduce healthcare costs for individuals and healthcare providers and limit the impact of disease on patients, families and communities. [3, 4]
The role of pharmaceutical companies
Pharmaceutical companies can play a significant role in expanding access to essential products, according to the 2024 Access to Medicine Foundation Index. Approaches that are used by the industry include: [2, 4]
Participating in patent pools and voluntary licensing programmes to make intellectual property available to companies developing and manufacturing drugs for underserved populations.
Donating research resources, including staff and facilities.
Making donations – from companies themselves, or through donor-driven procurement, for example for disease eradication programmes or emergencies.
Taking part in patient access programmes.
Creating partnerships with companies, institutions and non-governmental organisations (NGOs) to tackle access barriers and transfer knowledge.
Putting in place differential (tiered) and intercountry and intracountry pricing, adapted to ability to pay.
Strengthening health systems and supporting health and development goals.
Working with local stakeholders to ensure that programmes meet local needs.
Addressing health system capacity and supply chain constraints.
Moving the product focus beyond communicable diseases, including oncology, diabetes, cardiovascular disease and contraceptives. Developing therapeutics for communicable diseases, including malaria, neglected tropical diseases, tuberculosis and bacterial infection, is still an important goal.
Scaling up programmes long-term to include additional countries or products.
Case study: Novo Nordisk and iCARE
In 2021, Novo Nordisk launched the iCARE model to improve access to diabetes care in Sub-Saharan Africa, including Ethiopia, Ghana, Kenya, Mali, Nigeria, Senegal, Sudan and Uganda. The company expanded the project in 2023 to enable the low-cost supply of insulin to 4.1 million people with type 1 and type 2 diabetes across Africa by 2026. This supports the African Union’s Pharmaceutical Manufacturing Plan for Africa (PMPA) and was made possible through Novo Nordisk’s collaboration with Aspen. [2, 5]
Case study: Bristol-Myers Squibb and ASPIRE
Bristol-Myers Squibb’s ten-year ASPIRE strategy (Accessibility, Sustainability, Patient-centric, Impact, Responsibility and Equity) has a goal of reaching over 208,000 patients in LMICs per year by 2033. ASPIRE approaches include: [2, 6]
Creation of Emerging Market Brands with tailored tiered pricing reflecting each country’s ability to pay.
Collaboration with the Access to Oncology Medicines (ATOM) Coalition to improve access to cancer therapeutics in LMICs.
Establishment of the BMS-IMAP (Bristol-Myers Squibb Innovative Medicine Access Program), including direct import and direct-to-institution pathways that support importation of drugs.
Partnerships with healthcare provide...
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