Making access to medicines business as usual

How pharma companies can develop profitable ‘access to medicines’ initiatives in low-to-middle income countries


Access to medicines (ATM) in low-to-middle income countries has always been recognized as a moral – if not legal – obligation by pharma companies. The rapid growth of non-communicable diseases over the last decade and the impact of Covid-19 in 2020 have given unprecedented force and urgency to this duty. Until now, companies have typically met their ATM obligations through corporate social responsibility (CSR) initiatives, often as part of international non-governmental organization or philanthropic programs. However, ATM is rapidly becoming a key metric for pharma investors, employees and other stakeholders. The successful pursuit of a holistic approach to ATM can seize new business opportunities.

Investing according to environmental, social and governance (ESG) principles is booming – and when it comes to assessing the pharma industry, the ATM Index is increasingly used as a benchmark for ESG investments. At the same time, our analysis of employee satisfaction rankings at major pharma companies indicates that there is a correlation between high sustainability scores and creating a motivating working environment to encourage better performance across the business.

This report focuses on how pharma companies can put access to medicines for non-communicable diseases in low-to-middle income countries at the heart of their business strategies.

Our recent research and interviews with senior executives at leading pharma companies with responsibility for ATM, as well as with officials at international organizations focusing on promoting access to medicines, reveal the following five key findings:

1. Successful ATM initiatives for non-communicable diseases in low-to-middle income countries require a shift from vertical, disease-specific strategies to horizontal, holistic patient healthcare.

2. Pharma companies can enable this shift by making ATM an integral part of their business strategy, shifting towards an outcome-based approach and solutions beyond pricing.

3. ATM for non-communicable diseases in low-to-middle income countries can be a potential long-term revenue and profit driver for pharma companies, which requires executive level sponsorship and an adjustment to decision-making processes and business KPIs.

4. An effective growth strategy will involve pharma companies collaborating with each other and working closely with government and non-governmental stakeholders to create a new, effective healthcare ecosystem.

5. Those ecosystems – led by experienced international organizations – should foster cooperation using models comparable to the global vaccines alliance led by GAVI – The Vaccine Alliance.

Building a sustainabe ATM business: Key measures


There is no one-size-fits-all approach for developing a successful ATM strategy for non-communicable diseases in low-to-middle income countries.

The right strategy depends on a pharma company’s footprint, product portfolio and price level. Nonetheless, the measures we identify in this study are essential for the success of any strategy, which must always be conceived as an investment in future business rather than as a charitable CSR add-on. Designing a sustainable ATM program with an outcome-based approach and collaboration with local partners, seizing the investment opportunity by incorporating ATM into the company’s overall strategy, and cooperating with international stakeholders are the key actions to take.

In this context, pharma companies should develop a strategy that is adapted to a rapidly changing global non-communicable disease market. We expect Big Pharma companies increasingly to evolve into smaller, more specialized R&D groups focused on high-value blockbuster drugs for expensive treatments and rare diseases. A growing number have already begun to sell off their matured and primary care portfolios, mainly to generic manufacturers. These companies will have a greater market share in non-communicable disease medicines and will consequently need to take on greater responsibility for ATM in low-to-middle income countries. They, too, will need to make the conceptual leap from seeing ATM for non-communicable diseases as purely a moral duty to seizing the business opportunities in this long-neglected area.

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Holger Schmidt

Holger Schmidt

Partner, Strategy& Germany