ACCESS TO MEDICINE FOUNDATION

Patient centricity: How is thepharma industry addressing
patient reach?
SEPTEMBER 2024

For global health equity to become a reality, it is vital thatpharmaceutical companies expand access to medicine regardlessof where patients live or their socioeconomic status. By criticallymonitoring the number of patients they reach, companies canidentify persistent gaps, allocate resources to meet unmet needs
and amplify successful strategies more effectively. This reportassesses current approaches adopted by some of the largest
pharmaceutical companies to measure and report patient reach,mapping the existing landscape and highlighting interventions thatare critical to ensure more patients benefit from increased accessto medicine.

Measuring and reporting patient reach

ACKNOWLE DG E M E NTS

The Access to Medicine Foundation would like to thank the following
people and organisations for their support.
FU N D E RS

Bill & Melinda Gates Foundation
The UK Foreign, Commonwealth and Development Office
The Dutch Ministry of Foreign Affairs
The Leona M. and Harry B. Helmsley Charitable Trust
Wellcome Trust
AXA Investment Managers
Stewart Investors

R ES E ARCH TE AM

E D ITO R IAL TE AM

E XPE RT R E VI E WE RS

Chloë Snowdon

Elise Brunsvold

Hans Hogerzeil

Claudia Martínez
Swati Jha

Geetanjali Kapoor, One Health Trust India
AD D ITI O NAL CO NTR I B UTO RS

Iain Barton, MSH, Vizuri Health Dynamics

Anne-Charlotte Douard

Foundation, Health 4 Development
Patrick Flochel

ACCESS TO M E D I CI N E FO U N DATI O N

The Access to Medicine Foundation is an independent non-profit
organisation that seeks to transform the healthcare ecosystem bymotivating and mobilising companies to expand access to their essential
healthcare products in low- and middle-income countries.
Naritaweg 227-A
1043 CB, Amsterdam
The Netherlands
For more information about this publication, please contact
Claudia Martínez, Head of Research
cmartinez@accesstomedicinefoundation.org+31 (0) 20 215 35 35
www.accesstomedicinefoundation.org

2

Access to Medicine Foundation

Executive summary
Pharmaceutical companies play a pivotal role in ensuring that their products reachpatients worldwide. However, despite comprising 80 percent of the global population, people in low- and middle-income countries (LMICs) still face significant
challenges in accessing essential healthcare products. Reaching patients in theseunderserved regions is a central component of advancing overall healthcare equity.
Several essential health products are produced by only a few companies or evensingle suppliers, and in certain markets, there is little to no availability of quality
products. As demand for these essential products increases in LMICs, there is now
a pressing need for pharmaceutical companies to optimise their efforts to expand
access to their products and focus specifically on how many people are benefittingfrom them. By determining how many patients are being reached through theiraccess efforts, companies face a unique opportunity: they can address critical
health needs while also unlocking significant growth potential in these emerging
markets.
This report from the Access to Medicine Foundation assesses how companies
are approaching patient reach across their businesses. By outlining how the 20
pharmaceutical companies within the scope of the upcoming 2024 Access to
Medicine Index are tracking patient reach, this first-of-its-kind analysis provides acomprehensive overview of current industry practices to establish a baseline formeasuring progress. In identifying examples, as well as areas that require moreaction, the report outlines opportunities for companies to learn from existing
approaches and scale up their expansion efforts.
What does this report find?
Companies are utilising a variety of approaches to monitor and track patient reach.
Among these approaches, several are new while others are applied to long-standing
programmes. Five key findings illustrate the industry’s current practices regarding
patient reach, highlighting areas for improvement and opportunities for scaling successful strategies.
5 KE Y FI N D I NGS

1

19 out of 20 companies have established approaches, though
only a handful are comprehensive so far

2	
Sales volume is the primary measure of patient reach for­product-focused activities

3	
Patient reach approaches vary widely in product and country
coverage

4 Patient reach numbers are regularly published5	Many commitments by the industry, but only a few companies
set ambitious goals to address high-burden diseases

Read more on p.24 - 25 of the report.

3

Measuring and reporting patient reach

20 COMPANIES’ PATIENT REACH APPROACHES
AbbVie Inc

E FFO RTS EX AM I N E D ACROSS 113 LM I Cs

Astellas Pharma Inc
AstraZeneca plc
Bayer AG
Boehringer Ingelheim GmBH
Bristol Meyers Squibb Co
Daiichi Sankyo Co, Ltd
Eisai Co, Ltd
Eli Lilly & Co
Gilead Sciences Inc

SO M E O F TH E ▶ M
 ultidrug-resistant tuberculosis, which has an
G LO BAL H E ALTH

GSK plc

estimated prevalence of 624,840 cases in LMICs in

CO NCE RNS

Johnson & Johnson
Merck & Co, Inc (MSD)
Merck KGaA (Merck)

scope.17

AN D D ISE ASES
 alaria, tuberculosis and HIV/AIDS, which have a
COVE RE D I N TH E ▶ M
combined
prevalence of 1.8 billion people across
RE PO RT
LMICs in scope.17

Novartis AG▶S exual and reproductive health and rights: 164 million
women globally wish to delay or prevent pregnancy but

Novo Nordisk A/S

are not using any form of contraception. Sub-SaharanPfizer Inc

Africa exemplifies this gap, with the usage of modern

Roche Holding AG

contraceptives being the lowest in the world at 56%.19

Sanofi▶T he global prevalence of diabetes is expected toincrease to 783 million by 2045, with a high proportion

Takeda Pharmaceutical Co, Ltd

in LMICs.33

7 RECOMMENDATIONS FOR
THE PHARMA INDUSTRY▶N on-communicable diseases affect approximately 7.2

Read more on p.26-27 of the report.

KE Y FACTO RS▶V olume of medicines sold or donated

CO NSI D E RE D▶N umber of patients enrolled in patient assis-

BY CO M PAN I ES
WITH I N TH E I R
PATI E NT RE ACH
APPROACH ES

billion people globally, including 5.7 billion in LMICs in
scope.17

19/20 companies report1on their process formeasuring patient reachtance programmes▶N umber of attendees at education sessions▶A verage dosage, for instance, based on weight76%▶A verage treatment duration, based on the treat-98%

ment type and condition▶A dherence and compliance treatment rates,
tailored to specific populations (e.g., adults vs.
paediatric patients) or geographic regions▶R eal-world data on usage from insurance claims

Read more on p.10

19▶N
 umber of screenings undertaken

71%
38%
0● Underlying
20 40 60equation
80 10042 patient reachapproaches identified
across 20 companies
Read more on p.12

● Metrics● Assumptions● Limitations

and electronic health records▶D ata sourced externally from partners, including
actual number of patients receiving the company’s products or the volumes of products
supplied

15/42 approaches cover

2
15

14

all LMICs in scope
Read more on p.17

11
● All LMICs in scope● More than 50% of LMICs
in scope● Less than 50% of LMICs
in scope● Information not available

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Access to Medicine Foundation

Table of contents

6

About this report7

Introduction
Making sure patients most in need are benefitting from pharmaceutical companies’ access efforts

9

State of play
Why now and how did we get here?

10

Industry analysis

10	
Trends and developments
13	
A closer look at the approaches companies use to track patient
reach
17	
Country and product coverage vary significantly acrossapproaches
18	Are companies’ approaches backed by clear, measurable goals?
23	
Most approaches include publicly available patient reach data24	Key findings
Companies are prioritising patient reach, yet goals andapproaches vary in ambition and scope26

Next steps
How can companies expand patient reach efforts?

28	Definitions
29

References

5Measuring and reporting patient reach

About this report
This report is part of the Access to Medicine Foundation’s Access to Medicine Index
Programme, which aims to drive pharmaceutical companies to improve access totheir products in low- and middle-income countries (LMICs). Ahead of the 2024
Access to Medicine Index’s release in November, this report serves as a preliminary
analysis of the approaches to measuring and reporting patient reach that are being
employed by the 20 large research-based pharmaceutical companies in scope of the2024 Index. While this report provides broader insights into pharmaceutical companies’ practices, the forthcoming Index report will further evaluate product-specificexamples of patient reach and score companies as part of the overall Index analysis.
HOW TH IS RE PO RT WAS D EVE LO PE D
The analysis, findings and recommendations in this report have been drawn fromcompanies’ data submissions for the GA8 indicator ‘Measuring and reporting patientreach’, which is included in the Governance of Access Technical Area in the upcoming
2024 Access to Medicine Index. The report contains information uniquely provided
to the Access to Medicine Index Programme, exclusively for the Access to Medicine
Foundation. Some of this data is not publicly available. While the Index relies on proprietary data shared by companies, it also incorporates relevant public data sources
to complement and validate its analysis.
The report is also informed by inputs from two roundtables the Foundation heldwith companies on patient reach in 2023. These roundtables formed part of wider
stakeholder consultations for the 2024 Access to Medicine Index Methodology. In
addition, the report evaluates companies’ public commitments related to patientreach, alongside data from the Institute for Health Metrics and Evaluation (IHME)’s
Global Burden of Disease (GBD). The Foundation has made every effort to accurately
represent the data we obtained. The information was correct to the best of ourknowledge at the time of publication. However, there may have been subsequentdevelopments by the time the Access to Medicine Index is published in November
2024.
SCO PE O F TH E RESE ARCH
Companies
The analysis in this report covers the efforts of 20 research-based pharmaceutical companies to more transparently define, measure and report on
their impact in reaching patients living in LMICs. These companies will beassessed in the 2024 Access to Medicine Index and are selected based on
their market capitalisation and revenue, and the relevance of their productportfolios and pipelines for the diseases and countries in scope of the Index.
Products
The approaches employed by companies to measure patient reach are examined across the eight product types set out in the 2024 Access to Medicine
Index Methodology. The upcoming 2024 Access to Medicine Index will
additionally evaluate product-specific examples of patient reach within theframework of access strategies within the Product Delivery Technical Area.
Countries
Company actions are measured in 113 LMICs where better access to medicine is most urgently needed, as set out in the geographic scope of the 2024
Access to Medicine Index Methodology.

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Access to Medicine Foundation

I NTRO DUCTI O N

Making sure patients most in need are
benefitting from innovative pharmaceuticalcompanies’ access efforts
For global health equity to become a reality, all populations – including vulnerable
groups such as children, pregnant women and minorities living in low-and middle-income countries (LMICs) – must be able to access medicines and treatments when
they need them, no matter where they live. While achieving this requires coordinated, targeted action across the global health ecosystem, pharmaceutical companies – as the innovators, developers and distributors of essential healthcare products– play a key role in ensuring that their products reach people all over the globe.
Since the first Access to Medicine Index was published in 2008, pharmaceuticalcompanies have made significant strides in widening the scale and scope of theirefforts to expand access to their essential products in LMICs. However, the impactof this progress remains uneven, and billions of people living in LMICs still do nothave access to lifesaving healthcare products, including medicines, vaccines anddiagnostics.
Against this backdrop, it is now critical to analyse whether companies’ healthcare
products are effectively reaching patients. With companies’ various access efforts
maturing, and some already well established, it’s important to obtain more robust
insights on how they determine the number of people benefitting from their products. In other words: establishing how many patients they are reaching throughtheir access efforts. Although this isn’t a new concept for companies, they also needto start critically assessing whether the measurements of patient reach they now
use are accurate and detailed enough to successfully identify and address unmet
global health needs. By transparently defining, measuring and reporting on thenumbers of patients reached by their products, companies can assess successful
strategies and take further targeted action in addressing disparities and allocating
resources to improve health equity and the lives of underserved populations.
Publicly disclosing this information will also be vital since global health stakeholders – including governments, procurers and investors – have expressed anincreasing interest in better understanding the outcomes of companies’ efforts inreaching people in LMICs. With clearer and more accurate measurements of patientreach, stakeholders can make informed decisions about partnerships, policies andinvestments aimed at expanding access and enhancing global health outcomes.
How has the pharmaceutical industry evolved in measuring patient reach?
Previous research by the Access to Medicine Foundation – as part of the Accessto Medicine Index – has found that some companies have made targeted efforts
to monitor, quantify and share the number of patients being reached with theirproducts. However, approaches employed by companies have been varied and fragmented, with the scope of reporting on patient reach itself remaining somewhat
limited. Companies have tended to focus on specific products covered by accessstrategies, such as pricing strategies, donations and patient assistant programmes.
Companies have also demonstrated more consistent tracking and reporting on
patient reach for select initiatives aimed at improving access to their products in
LMICs. These initiatives, which often have specifically-named identities, help companies in terms of visibility and partnerships. Often featured on companies’ websites, they normally have clearly defined goals, strategies and public commitments,

7

Measuring and reporting patient reach

including reporting on patient reach. Additionally, these endeavours encompass a
range of elements, including equitable pricing strategies, capacity building and healthsystem strengthening.
Some of these initiatives are not purely philanthropic in nature, striving for longevity
through the development of LMIC-specific business models and sustainable sources ofrevenue. Simultaneously, they are designed to be long-term, systematic approaches toexpanding access in LMICs. Across the industry, new commercial programmes and both
year-long and long-term initiatives are emerging, all focused on enhancing patient reach.
Examples include Novo Nordisk’s recently launched iCARE, a business-integrated
model targeting improved access to diabetes treatment in 49 sub-Saharan Africancountries.1 Similarly, Sanofi’s Global Health Unit aims to widen access to 30 medicines
across 40 LMICs, while also working towards self-sustainability and bolstering healthsystems in these countries.2 Pfizer’s Accord for a Healthier World strives to provide
equitable healthcare to up to 1.2 billion people by offering patent-protected medicinesand vaccines to 45 LMICs on a not-for-profit basis.3 Additionally, Bristol Myers Squibb
recently launched its ASPIRE (Accessibility, Sustainability, Patient-centric, Impact,
Responsibility and Equity) strategy, which aims to advance access to innovative treatments in LMICs.4 Meanwhile, Bayer established a Global Health Unit aimed at improving
access to medicines in LMICs.5
Conversely, other endeavours prioritise non-commercial efforts aligned with corporate social responsibility and philanthropic programmes. These include AstraZeneca’s
Phakamisa programme in South Africa, aimed at enhancing the diagnosis, treatment
and management of breast and prostate cancers within the public healthcare system.6
Additionally, Boehringer Ingelheim’s Making More Health social entrepreneurship programme and MSD’s Mectizan® donation programme for the elimination of onchocerciasis and lymphatic filariasis, exemplify such non-commercial endeavours.
Even for initiatives and programmes where patient reach data is more available,
reporting by companies across their portfolios remains unclear or insufficient. The
2022 Access to Medicine Index highlighted this issue, revealing that, for instance,
while some companies are measuring patient reach and associated health outcomes incommercially-named initiatives, this practice is not widespread across all companies.
The 2022 Index also identified that fewer than half of the evaluated companies weretracking donations until they actually reached patients. The 2024 Access to Medicine
Index, due for publication in November 2024, will further explore companies’ progressin these areas.
Why patient reach matters in today’s industry
By setting clear and ambitious goals for expanding access to lifesaving treatments in
LMICs, and regularly tracking and reporting progress, pharmaceutical companies canunlock various benefits. This strategy will not only help deliver essential medicines tosome of the world’s most impoverished populations but will also pave the way for longterm business sustainability and growth. Representing about 80 percent of the world’s
population, LMICs have large, underserved patient populations, offering companies theopportunity to access new markets.
Prioritising patient reach can also drive companies to innovate, widening productavailability in LMICs, exploring alternative business models and crafting access strategies tailored to these markets. This not only advances health equity but does so sustainably. Access to medicine is also a key component of environmental, social and governance (ESG) considerations for investors, with patient reach becoming an increasingly important topic for them as they work to help guide sustainable practices acrosspharmaceutical companies. Moreover, setting patient reach as a measurable goal andaligning it with disease burden and treatment eligibility as a business goal can unify theentire organisation – from the CEO and senior managers to employees – toward thecommon objective of improving more patients’ lives. This alignment can also enhance
employee retention and attraction, as employees are more likely to stay with and joincompanies that demonstrate a clear and impactful mission.
8

Access to Medicine Foundation

STATE O F PL AY

Why now and how did we get here?
Pharmaceutical companies are facing mounting external pressure to demonstrate
how they are reaching more patients globally, especially in LMICs, and they havemade numerous public commitments to this goal. The Foundation’s work to datealso reveals a gradual and noticeable shift in prioritising the measurement andtracking of patient reach. However, these efforts have been somewhat uneven,indicating a need for a more consistent and comprehensive approach. Moving forward, it’s imperative to clearly establish how companies are making commitments,
delivering on them and reporting their outcomes. That’s why, for the first time, theFoundation is critically examining this aspect to gain deeper insights into the current patient reach landscape and ongoing company efforts.
To facilitate this shift, the Foundation held two workshops in May 2023, engaging
all 20 companies within the scope of the Index to delve into their prevailing definitions and measurement methods for patient reach. These workshops were part ofbroader methodological consultations involving over 100 global stakeholders aimed
at enhancing the Access to Medicine Index’s indicators. The Foundation also used
these sessions to explore ways to collect and present patient reach data in a manner
beneficial to companies, their partners, governments and global health organisations.
Among other insights, the workshops revealed that many companies have distinct definitions of what constitutes patients reached. Additionally, they consider
different factors, such as product usage and healthcare outcomes, when measuring
it. This lack of uniformity creates a patchwork landscape, making it challenging toassess overall progress in improving access to medicines across the industry andhindering the identification of best practices and areas for improvement.
Based on these insights and the recommendations from the Access to Medicine
Index Expert Review Committee, a refined definition of patient reach (see definitions on p.28) was developed for assessing companies’ patient reach methodologies in the 2024 Access to Medicine Index. In addition to patient reach remaining
part of the Index’s Product Delivery assessment, a new indicator has been introduced in the Governance of Access assessment, which aligns with the Foundation’s
refined definition of patient reach (see box below).

Enhanced focus on patient reach for the 2024 Index
Although patient reach has always formed part of the Product Delivery assessment within the
Access to Medicine Index, the Foundation’s increased focus on patient reach is reflected in manyof the enhancements and updates to the 2024 Index Methodology that will be used to assessand compare companies in the upcoming Index. Notably, a new priority topic on measuring
and reporting patient reach has been introduced in the Governance of Access Technical Area,
which will look at the success of companies’ strategies in ensuring their essential healthcare
products reach patients living in LMICs. This includes a standalone patient reach indicator, “GA8:
Measuring and reporting patient reach”, which will evaluate how companies define, measure, andreport on patient reach. Specifically, whether the company has a process in place for measuring
patient reach that:a) Is publicly available in terms of underlying methodology (equation/ metrics/ assumptions/limitations);b) extends across the company’s portfolio, for diseases within scope of the Index;c) covers all countries within scope of the Index, where the company’s products are sold;d) regularly reports resulting patient reach numbers publicly;e) incorporates clear goals and objectives to measure and improve* patient reach and associated health outcomes over time and can demonstrate such improvements.

*Improvement in patient reach does notnecessarily mean an increase in patients
receiving a product (for example, where
the goal of a product is elimination or
eradication of a disease).

9Measuring and reporting patient reachI N DUSTRY ANALYSIS: OVE RVI EW

Trends and developments
Most of the companies assessed in this report aspire to reach more people in lowand middle-income countries (LMICs) with their products, as evidenced by thehigh-level engagement the Foundation had on this report. Factors such as tailoredapproaches to measuring the number of patients reached with products, definedgoals to reach more patients and the reporting of related data drive these aspirations. In conjunction, these factors support companies’ patient reach efforts andtranslate ambitions into actionable strategies. The following analysis of 20 companies highlights trends and developments made in these various areas as identified
by the Foundation.
Almost all companies have a process in place for measuring patient reach
Nineteen of the 20 companies assessed report having an approach to measuring

FIGURE 1 How many companies have

patient reach in place (see Figure 1). This indicates a widespread effort within theprocesses for measuring patient reach inindustry to understand and quantify impact on patient access, which is a step in theplace?

right direction. Currently there is no consensus on how the industry should calculate
the numbers of patients being reached, with a variety of methods being employed.
Among these 19 companies, 42 unique approaches to measuring patient reach wereidentified. The highest number of unique measurement frameworks shared by a

AbbVie did notreport a process formeasuring patient
reach

1
20
companies

single company was four.
To help foster industry-wide learning and identify gaps and areas of improvement, companies can publicly share information about how they develop and apply
these approaches to measuring patient reach. Overall, companies’ submissions var-

19

Reported a process
for measuring
patient reach

ied in clarity and transparency. Some companies provided all details about how theymeasure patient reach publicly, some provided details both publicly and directly to
the Foundation, while others submitted under a non-disclosure agreement (NDA).
Notably, 11 companies – Astellas, Bristol Myers Squibb, Boehringer Ingelheim,
Daiichi Sankyo, Eisai, Gilead, GSK, Johnson & Johnson, Merck KGaA, Pfizer andRoche – provide insights into their processes for measuring patient reach partiallyor entirely under an NDA.

FIGURE 2 Out of 42 approaches for measuring patient reach, 15 were
submitted under a non-disclosure agreement (NDA)
Details on howpatient reach ismeasured submitted
partially or entirely
under an NDA

15

42approaches

21

Details on how patientreach is measured are
publicly available

6
Details on how patient reach ismeasured submitted partially or
entirely to the Foundation directly,
but not shared under an NDA

10

Access to Medicine Foundation

Companies have approaches for measuring patient reach across three types ofaccess activities
Companies engage in various activities to expand access to medicine, as outlined
below. The analysis shows that each of these three types of activities is supported byapproaches to measure their impact on reaching patients. These activities include:• Product-focused activities that involve the direct sale or donation of products
within a company’s portfolio.
• Non-product activities focused on capacity building and health systems strengthening. For instance, disease awareness campaigns and health education.
• Activities that involve both product-related and non-product-related initiatives.
Eighteen out of the 19 companies that reported a patient reach measurement process detail an approach for product-focused activities. AstraZeneca, Sanofi and acompany that provided data to the Foundation under an NDA reported approaches
for non-product activities. Eli Lilly, Novo Nordisk and a company that submitted data
under an NDA reported using an approach for activities that combine product-related
and non-product-related initiatives.

FIGURE 3 Which approach is most used by companies to measurepatient reach?

Four approaches
address non-productactivities

4

Three approaches address activities
that integrate both product-related
and non-product elements

342
approaches
35Over 80% of the reported approaches
address product-focused activities

Companies mostly provide metrics but few share full calculation processes formeasuring patient reach
The level of detail provided by companies on how they developed their patientreach approaches varies greatly.
Among the 42 approaches reported by companies, the vast majority (41) detailthe included metrics. However, 10 do not provide the underlying equation. It is
encouraging that companies are publishing their metrics, but it is also importantthat they disclose the equation those metrics fit into. This transparency allows
understanding of the actual calculations and how patient reach is being measured.
Regarding the other two elements, only 30 out of 42 approaches include
assumptions and only 16 include limitations.

TABLE 1 The 4 elements of a full patient reach approach
Components

Description

MetricA measure used to track and assess the status and performance of a specific process,activity or objective. For example, the number of vaccines administered, or number of
products sold.

Underlying equation

The formula or method used to combine the individual metrics to derive the final
patient reach number. For example, dividing the total sales volume of the product by
therapy days and dose.

Assumption

A condition accepted as true, which can serve as a starting point for analysis. For example, a presumption about global average dosing or treatment duration.

Limitation

A factor that might restrict the accuracy or reliability of the patient reach calculations.
For example, patients are counted multiple times if they use a product more than once.

11

Measuring and reporting patient reachNine companies, including Johnson & Johnson, Takeda, AstraZeneca, Novo Nordisk,
Roche, Novartis, MSD and two that shared information under an NDA, provided atleast one approach that demonstrates the full underlying process (see Table 1 onp.11), covering the equation, metrics, assumptions and limitations. This level of detailallows understanding of the calculation behind the patient reach figures and reveals
how companies consider potential drawbacks and assumptions in their methods.

FIGURE 4 Percentage of approaches that include the underlying
equation, metrics, assumptions and limitations
42 approaches

76%
98%
71%
38%
0

20

40

60

80

12 approaches include all four
components. These are allapproaches addressing productfocused activities.

100● Underlying equation● Metrics● Assumptions● Limitations

Patient reach mostly measured by volumes of products sold or donated
About half of the approaches reported quantify patient reach by using a volumeto-doses formula, which involves dividing sales and/or donations volume data bydosing estimates and treatment duration assumptions. While this is a good gaugeof the potential number of patients reached, it is a caveated method; just because a
product is delivered, does not mean it successfully reaches the patient.
Number of doses of a product sold/donatedAverage daily dose x Average duration of treatment

Seven companies, including AstraZeneca, Novartis, Roche and four others that
submitted under an NDA, have taken steps to improve the accuracy of their sales
volume calculations by integrating assumptions about treatment adherence. For
example, one company reports that for specific treatments, it uses real-world datafrom insurance claims and information from electronic health records to obtain amore complete picture of treatment adherence. This shows that some companies
are enhancing their volume-based approaches to produce more precise patientreach numbers. Furthermore, while most companies base their assumptions on
World Health Organization (WHO) guidelines and recommendations for average
daily dose and treatment duration, Novartis takes additional steps to refine theaccuracy of its assumptions. Novartis stated that although it generally utilises WHO
global assumptions in its patient reach approaches, it makes adjustments based on
country or product-specific data as necessary.

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Access to Medicine Foundation

I N DUSTRY ANALYSIS: M E ASU RE M E NT FR AM EWO RKS

A closer look at the approaches companies
use to track patient reachAs discussed earlier in this industry analysis, the Foundation has categorised theaccess activities of companies into three categories: product-focused, non-productand those that involve both product-related and non-product-related efforts. The
following section delves into the application of the approaches companies use tomeasure the reach of these different types of activities.

1	Companies offered diverse levels of detail for approaches addressing
product-focused initiatives: interesting examples identified
Most companies offered approaches to measure the number of patients reachedby the products within their portfolios, providing varying levels of detail. These
approaches range from high-level overviews to more granular analyses of individual products. It is common for these approaches to focus on wider groupingsof products, sometimes based on factors such as therapeutic area. By aggregating products into these categories, companies can gain a high-level view of theiroverall impact and reach. A few companies have also implemented approaches togauge the reach of individual medicines.
▶B ayer’s approach for contraceptives and Novo Nordisk’s methods fordiabetes products
Bayer provided a detailed approach focused on its contraceptive products,­sharing how it reaches people living in LMICs. The company explained its two-step­process: first, extracting and cleaning the relevant sales data, and then calculating
the number of women reached. Bayer also demonstrated that it is able to calculate patient reach for both short-acting (such as oral contraceptives and injections) and long-acting (such as intrauterine devices and implants) contraceptive
methods to produce more precise patient reach numbers. Novo Nordisk’s comprehensive approach includes three measurement frameworks centred aroundits diabetes care products. All of these frameworks provide the four elements theFoundation seeks for calculating patient reach (see Table 1 on p.11). This includes
Novo Nordisk’s process for quantifying the overall number of patients reachedwith its diabetes care products, the approach underpinning the Access to Insulincommitment – through which the company pledges to provide human insulin at or
below a USD 3 ceiling price to 77 countries7 – and the approach for iCARE.
▶ Novartis and Sanofi provided more details on their approaches for productaccess activities as part of sustainability-linked bond frameworks
Sustainability-linked bonds (SLBs) provide financing to companies committed
to improving specific sustainability outcomes, which may be defined as environmental, social and/or governance-related (see definition on p.28). These facilitate ongoing monitoring and assessment of progress, thereby enabling companies to demonstrate their performance to investors. Sometimes the frameworks
can also act as an incentive for companies to establish clearer, more robust
approaches to measuring and enhancing patient reach.
Within their respective SLBs, Novartis and Sanofi have set patient access targets, with both companies sharing comprehensive information on the underlying
equations, metrics and assumptions that underpin their approaches for measuring the reach of their product-focused activities aligned with these targets.

13

Measuring and reporting patient reach▶ Varied commitment to measuring patient reach within large accessprogrammes and inclusive business models
When companies establish large access programmes or inclusive business models with large patient reach objectives aimed at enhancing access to a broad
portfolio of their products in LMICs, they are expected to develop clear, robust
approaches for measuring patient reach. Additionally, due to the public-facing
nature of these commitments and their potential impact, there is an incentive forcompanies to publicly share details about their measurement approaches.
Sanofi’s Global Health Unit is an example of a dedicated model for improving
access. The company’s approach for measuring patient reach was based on thework of this unit, aiming to address access in 40 LMICs for 30 of its non-communicable disease (NCD) products.2 For this approach, Sanofi publicly provided
the details of the underlying equation, metrics and assumptions. Another large
access programme is Pfizer’s An Accord for a Healthier World, launched in 2022,
which aims to provide all its patented medicines and vaccines at not-for-profit
prices to 45 lower-income countries.3 However, notably, the company did not
publicly report any details of the approach it is using to measure patient reach of
the Accord.
▶ How are companies measuring the reach of their product donation
programmes?
There are different ways in which pharmaceutical companies engage in partnerships to expand access to medicines in LMICs. These methods include collaborating with NGOs and local implementing organisations through accessprogrammes or providing free or discounted medicines to eligible individuals
and organisations through patient assistance programmes (PAPs). One partner in such efforts is the Max Foundation, a global health non-profit organisation. Through its collaborations with companies, the Max Foundation receives
donated cancer treatments and distributes them at no cost to underserved
patient populations in LMICs. Organisations like this already individually trackpatients, monitor where medications are delivered and, in some cases, verify thatthe intended recipients are successfully accessing the treatments.
The approaches reported by companies show that in more controlled settings,
collaborating with NGOs or local implementing organisations on targeted initiatives, such as PAPs, results in simpler yet more precise methods. For instance,patient enrolment in a PAP is typically equivalent to patient reach. Collaboratingand embedding patient reach in partnerships is an important step, helping
companies obtain more accurate, on-the-ground data. This should be a shared
responsibility among all partners. Such collaborations can be instrumental inunderstanding the impact of the programmes, allowing companies and theirpartners to adapt as needed and continuously refine measurement approaches.
A small number of companies evidenced that their implementing partners report
actual numbers of patients reached, rather than relying on estimates calculatedusing broad assumptions on patient use. Interestingly, this seems to apply primarily to smaller-scale partner programmes.
Several companies also make larger-scale product donations of their medicines to global health organisations for distribution in LMICs or for humanitarian
aid and disaster relief. Many companies in scope have long-running donation
programmes targeting the elimination of specific diseases, in partnership withorganisations such as WHO, with goals shared and publicised on their websites.
For instance, Gilead and WHO have continued their collaboration, which includes
the donation of AmBisome® for the treatment of visceral leishmaniasis.8 As partof its schistosomiasis elimination programme, Merck KGaA (Merck), has donated2 billion tablets of praziquantel to WHO.9

14

Access to Medicine Foundation

In contrast to the smaller-scale partnerships, larger donation programmes
often rely more on assumptions around patient use to calculate the number ofpatients reached. Unlike smaller-scale programmes where companies receive
direct patient reach numbers from partners, these larger programmes seem toinvolve companies calculating patient reach based on the total number of doses
donated divided by assumed doses per patient.
Among the examples available, Eisai provides evidence of the equation, metrics and assumptions used for its long-term donation of diethylcarbamazine
tablets to combat lymphatic filariasis in partnership with WHO. To estimate
the number of patients reached, Eisai considers the average dosage based on
WHO’s recommended number of tablets per person and the total quantity of
donated drugs. Johnson & Johnson shares information regarding the calculation
under-pinning its chewable mebendazole (Vermox®) donation programme forintestinal worms, for which it has committed to provide up to 200 million doses
per year through 2030.10 The specific details on how patient reach numbers arecalculated were shared under an NDA.

2	Some approaches track the reach of capacity building and health systemstrengthening efforts
In addition to approaches that measure the reach of product-focused activities,
three companies reported measurement frameworks focused on assessing
the reach of initiatives aimed at strengthening healthcare systems and building
local capacity for product administration in LMICs. These initiatives, whether
integrated into broader access programmes or implemented to support more
localised patient reach objectives, encompass various activities such as healthcare worker training, educational campaigns and screening and diagnostic
programmes.
Examples include AstraZeneca’s Healthy Heart Africa (HHA), Young Health
Programme (YHP) and Healthy Lung programmes. These initiatives aim to
improve access to care for various diseases in LMICs through actions such as
partnerships, capacity-building initiatives, screenings, patient education andhealthcare provider training.11
AstraZeneca reported an approach for assessing the number of patientsreached through these programmes, detailing the underlying equation andmetrics of this approach. This demonstrates that actual patient interactions aremeasured, enabling the company to potentially gain insights into various aspects
such as patient needs, how products are being used and factors that influence
treatment adherence.
Overall, the four approaches reported under this category involve collaborative efforts with partners, such as governments and NGOs. These partnerships
can play a crucial role in refining measurement approaches and facilitating moreaccurate data collection by directly measuring patient interactions.

3	Findings on approaches that measure the reach of initiatives that combine
product access and health systems strengthening
Three companies report patient reach through approaches measuring the reachof activities that integrate both product-focused and non-product elements.
Some of these approaches are quite straightforward, with the resulting patientreach numbers originating from a single programme of work. For example, Novo
Nordisk reported on its Changing Diabetes® in Children (CDiC) programme,
which provides both patient education and medical supplies.7 Novo Nordisk
detailed the underlying equation and metrics for this approach, reporting thatpatient reach is measured by the number of patients enrolled in the programme.

15

Measuring and reporting patient reach

Other approaches reported under this category are more complex, combining
the reach of multiple programmes of work into a single patient reach figure. Eli
Lilly disclosed the metrics, underlying equation and assumptions for the measurement process of its Lilly 30x30 initiative, a company-wide programme forincreasing access to its medicines in resource-limited settings, including both
LMICs and high-income countries.12 Eli Lilly reported how it tracks patient reachnumbers through a combination of sales data, product donations and individuals reached through partnership programmes, such as the Life for a Child programme, which provides treatment, supplies and diabetes education. However,
the way in which patient reach is measured and calculated for these individual
programmes, contributing to the overall total, is less clear. Disclosing more granular information on the calculations used at the programme level can enhance
how patient reach is understood, allowing assessment of whether target populations are effectively being reached.
Thus, while approaches that measure the reach of activities integrating bothproduct-focused and non-product elements can help track patient reach acrosswider programmes, in some cases, greater disaggregation is needed.

16

Access to Medicine Foundation

I N DUSTRY ANALYSIS: COVE R AG E

Country and product coverage varysignificantly across the approaches
Across the 38 approaches out of 42 that address access efforts involving products (including activities that are purely product-focused and those integrating
both product-related and non-product elements), companies vary in their scope(see Figure 5). Some include all products within the Index’s scope, others focus onsubsets of companies’ portfolios, and a few target just one product. For instance,
Eisai provided two approaches, each measuring the reach of a single product, while
Roche reported two approaches that each measure the reach of more than halfof its products in the Index’s scope. This variation highlights the diverse strategies companies employ to measure patient reach, with some opting for focused
approaches and others measuring the reach of multiple or all products.
Similarly, the geographic coverage of the 42 approaches varies (see Figure 6).
Some companies measure reach in all countries they operate in, including all thosein the Index’s scope, while others include only a smaller proportion of countries. For
two approaches, the specific countries included could not be established.
Among the 19 companies reporting approaches, Astellas, AstraZeneca, MSD,
Novartis, Pfizer and another company that reported information under an NDA
exhibit patient reach approaches covering all countries in which the companies
operate (i.e. including countries outside of the scope of the Index as well as those inscope). These approaches also cover all products in scope of the Index, along withproducts not in scope.

FIGURE 5 Fifty-three percent of approaches that include products

FIGURE 6 Sixty-two percent of approaches cover all or a majority ofcover all or a majority of the company’s products

the countries in scope of the Index in which the company operates

8 approaches
focus onone in-scopeproduct

For 2 approaches,
information on thenumber of countries
included could not
be established

8

10 approaches include
all the company’s
in-scope products

1038
approaches
10 approaches
include fewer
than half ofthe company’s in-scopeproducts

10

10 approaches include
more than half of thecompany’s in-scopeproducts

10● All products● More than 50% of products● Less than 50% of products● One product*The analysis of the country coverage ofeach approach considered the prevalenceof the disease(s). This means that for
approaches targeting diseases only prevalent in a subset of the in-scope countries,
only those countries where the disease isprevalent were assessed. For example, if
an approach was reported to include all
30 countries in which a disease is prevalent, that approach was assessed as covering all LMICs in the scope of the Index.

14 approaches
include fewer thanhalf of the LMICs in
scope of the Index inwhich the company
operates2
14

42
approaches

1511● All LMICs in scope● More than 50% of LMICs
in scope● Less than 50% of LMICs
in scope● Information not available

15 approaches include
all LMICs in scope of
the Index in which thecompany operates*

11 approaches include
more than half of the
LMICs in scope of theIndex in which thecompany operates

17

Measuring and reporting patient reachI N DUSTRY ANALYSIS: GOALS

Are companies’ approaches backed by clear,measurable goals?
When companies have goal-driven approaches, they gain a clear direction and purpose in their patient reach efforts. Without these objectives, they risk operating
without a defined path, making it hard to measure success and identify areas for
improvement. However, merely having targets is not enough; the quality of thesegoals also matters. High-impact goals are not just clear and well-defined; they arealso measurable, specifying the exact number of patients they aim to reach and thetimeline for achieving this, enabling precise tracking of progress and performance.
This combination ensures companies stay on course and continuously enhancetheir impact.
The following section includes an overview of the assessed companies’ goals
that are tied to patient reach approaches. Goals that are not connected to patientreach approaches are, therefore, not considered within the analysis. However, it isimportant to note that goals alone do not ensure patients are reached; the affordability and availability of products significantly aid in achieving these objectives.

FIGURE 7 How many approaches are supported by a patient reach goal?

FIGURE 8 The majority of goals set by companies are clear andOf the 42 patient reach approaches identified in this report, 31% do not havemeasurable

a patient reach goal.

Of the 29 patient reach goals identified, more than 70% are clear andmeasurable.

13 approaches
have no goalat all13

29 approaches
have a patientreach goal

42
approaches
29

8 of thepatient reachgoals are notclear andmeasurable

8

21 of the patientreach goals are clear
and measurable

29
goals
21

Which diseases are included in companies’ goals?
Another impactful aspect of patient reach goals is the specific diseases they target,
as this can directly address major health challenges in underserved populations.
Further analysis of companies’ goals shows a focus on a range of diseases, many ofwhich pose a high burden for patients, especially those in LMICs. For instance, Eisai,
Johnson & Johnson and Merck each target different neglected tropical diseases(NTDs): lymphatic filariasis, intestinal worms (or soil-transmitted helminths) andschistosomiasis, respectively. These parasitic infections disproportionately affectpeople in LMICs, particularly those living in impoverished areas. If left untreated,
they can lead to severe health consequences, including disability, the progression tochronic conditions or even death.13
While all 20 companies have products for non-communicable diseases (NCDs)
within their portfolios, companies such as AstraZeneca, Bristol Myers Squibb, Eli
Lilly, Merck, MSD, Novartis, Novo Nordisk and Sanofi shared approaches with goals
specifically associated with NCDs like diabetes, cancer and cardiovascular disease. Companies such as GSK and Johnson & Johnson have stated commitments
to tackling communicable diseases like tuberculosis, malaria and HIV. However,aside from Bayer’s goal regarding contraception, which reflects its major product18

Access to Medicine Foundation

portfolio focus on women’s health, there are limited commitments to reproductive,
maternal and newborn health conditions among the companies in scope.
Certain companies commit to ambitious and well-planned targets for diseases
with high global burdens
Addressing disease burden and unmet health needs in LMICs is a collective responsibility involving various stakeholders, including pharmaceutical companies, governments, national and local health authorities and global health organisations.
Aspirational, specific, measurable and achievable patient reach commitments fromcompanies can help drive progress. To set effective patient reach goals, companies
must consider the following factors:• Understanding the treatment-eligible patient group: It is crucial to identify thetreatment-eligible patient group for products, both globally and within LMICs, so
patient reach can be accurately measured.
• Assessing disease prevalence: Understanding disease prevalence is essential formeasuring patient reach. Disease prevalence quantifies the number of individuals living with a disease at a specific point in time, providing an indication of theaffected population. This report uses data from the Institute for Health Metrics
and Evaluation (IHME)’s Global Burden of Disease (GBD) 2021 to highlight significant opportunities for companies.
• Prioritising products in concentrated markets: When the manufacture andsupply of products are concentrated among a few or sole companies, these companies bear a greater responsibility for ensuring that products are available, andpatients are reached.
Bayer, GSK and Johnson & Johnson have set goals that align with some of these
input parameters, showing promise for improving patient reach and demonstrating
meaningful progress if achieved.

Johnson & Johnson’s MDR-TB commitment
Johnson & Johnson has established detailed and measurable

in scope alone, according to IHME’s GBD data from 2021.17

patient reach objectives as part of its Health for Humanity

Against this backdrop, Johnson & Johnson’s goal of provid-

2025 Goals. For example, by 2025, the company states it

ing bedaquiline to 700,000 patients could have a significant

aims to enable access to bedaquiline for 700,000 cumulative

impact in tackling this pressing global health issue. To help

patients globally, reporting that it could potentially avert

achieve this, the company has entered into an agreement

6,000,000 new cases of new cases of multidrug-resistantwith the Stop TB Partnership’s Global Drug Facility to enabletuberculosis (MDR-TB). Johnson & Johnson reported thatthe tendering, procurement and supply of generic versions

in 2022, the drug had been made available in 158 countries,

of bedaquiline to LMICs.

including all 30 countries with the highest burden.14
Bedaquiline is a core component of the treatment

Given that Johnson & Johnson is a major global supplier of bedaquiline and has an extensive operational reach­regimen recommended by WHO for MDR-TB, which refers

in countries with a high burden of TB, the scope of theto TB strains that do not respond to at least the two most­company’s initiative is achievable. By developing this com-potent anti-TB medications, isoniazid and rifampicin.15

mitment with underlying metrics to measure progress, theAccessing treatment for MDR-TB in LMICs is challenging.

company demonstrates that its 2025 goal is also backed

Lack of access to the appropriate MDR-TB treatment canby an approach that will track whether patients are being

potentially lead to worsening of the disease for patients inreached. Johnson & Johnson reports that 210,536 patientsthese regions.

received access to the bedaquiline molecule (branded and

15,16

The estimated global disease prevalence of MDR-TB is

generic) via its initiative in 2023.18

653,669 cases, with 624,840 patients affected in LMICs

19

Measuring and reporting patient reach

Bayer’s contraceptive access initiative

GSK’s global health access goal

There is a significant unmet need for family plan-

GSK has also established a clear and focused goal,ning globally, with 164 million women of reproduc-stating it aims to provide medicines and vaccines

tive age who wish to delay or prevent pregnancy

to 1.3 billion people in lower-income countries by

but are not using any form of contraception. Sub-

2030. This initiative targets diseases including

Saharan Africa exemplifies this gap, with the usage

malaria, TB, antimicrobial resistance (AMR) andof modern contraceptives being the lowest in the

HIV/AIDS (through ViiV Healthcare).21 According

world at 56 percent.

to IHME’s GBD data from 2021, the combined

19

The gap in contraceptive care remains a sig-

prevalence of malaria, TB and HIV/AIDS in LMICs

nificant ­challenge. However, if more companies

in scope totals approximately 1.8 billion people,

actively engage in this sector and set ambitious

emphasising the urgent need for effective interven-

goals, including Bayer, there is potential to meettions.17 Furthermore, AMR poses a significant global

this critical need. Bayer’s reported ­commitment

health threat, contributing to around 1.27 million

to meet the contraceptive needs of 100 million

deaths annually, with a particularly high prevalence

women in LMICs by 2030 exemplifies the impact

in low-resource settings. Projections suggest thatthat collective efforts can achieve. This commit-

if left unaddressed, AMR could result in up to 10

ment includes the use of modern contraceptive

million deaths per year by 2050.22 In 2023, GSK

methods, both short-acting and long-acting.

reported having reached 89 million people* with

20

Bayer’s targeted effort to increase access canvaccines and antiretrovirals and made 989 million

help address this unmet gap, significantly improv-

doses of products available in lower income coun-ing reproductive health outcomes for millions oftries via its initiative.23

women in LMICs. As mentioned earlier in this section, this realistic yet high-reaching goal also has acomprehensive approach to track its progress. Asof 2023, Bayer reports having already reached 46
million women in LMICs via its access efforts.20

Examples of goal setting with potential for further refinement
Other companies in scope have also set goals targeting a variety of diseases
through diverse efforts. However, upon analysis, the Foundation has identified thatsome of these goals could be further refined. It is encouraging to see patient reachbeing prioritised by companies overall, but to maximise impact, some goals could
benefit from being more ambitious or more specific.
Companies’ commitments towards addressing NCDs
NCDs are chronic diseases that are rising rapidly worldwide and are the leading
cause of death globally. The most prevalent NCDs include cardiovascular diseases,
diabetes, cancers and chronic respiratory diseases.24 According to IHME’s GBD datafrom 2021, NCDs affect approximately 7.2 billion people globally, including 5.7 billion
in LMICs in scope.17 Several companies have established goals for addressing NCDs,
either through direct commitments or by integrating NCDs into broader patientreach objectives.
▶ Merck states its aim to provide access to more than 80 million patients per
year in LMICs across Africa, Asia, Latin America and the Middle East, focusing on NCDs such as head and neck, colorectal and bladder cancers, as well as
thyroid disorders. As part of this, Merck’s Systemic Health Access and Patient
Enablement Program (SHAPE) aims to expand patient access to both existing
and upcoming products by implementing health system strengthening initiatives,
developing equitable pricing strategies and streamlining regulatory processes. In
2023, the company reports reaching 57 million patients in LMICs with its healthcare portfolio.25*This does not include people
reached through the albendazole
donation programme.

20

Access to Medicine Foundation▶ Novartis has stated its commitment to increasing patient reach with its innovative therapies in LMICs by at least 200 percent by 2025, targeting to reach 1.6
million patients compared to 0.5 million in 2019. This commitment encompasses
access to various treatments, including Entresto® (sacubitril/valsartan) for
heart failure, supplied through the company’s emerging market brands (EMB)
programme, which aims to make medicines more affordable in resource-limited
settings. According to company reports, Novartis reached its goal of 1.6 million
patients in 2023.26,27▶A s part of MSD’s reported commitment to enabling 350 million more people
to access its innovative portfolio by 2025, the company is focusing on building
healthcare capacity, strengthening channels for care delivery and fostering sustainable financing through dedicated access strategies, solutions and partnerships. This includes optimising patients’ cancer journeys from early diagnosis totreatment, preventing HPV-related cancers through expanded access to its HPV
vaccines in countries supported by Gavi, the Vaccine Alliance, and implementing
access strategies for communicable diseases such as COVID-19. According tocompany reports, MSD has reached 189 million people as of 2022 via its accessefforts.28▶M eanwhile, Bristol Myers Squibb states that its Accessibility, Sustainability,
Patient-centric, Impact, Responsibility and Equity (ASPIRE) strategy aims toenhance the accessibility and affordability of its innovative treatments in LMICs,
including to cancer treatments. This strategy aligns with the company’s reported
goal to provide innovative treatments to over 200,000 patients in LMICs by
2033.4 As of 2023, Bristol Myers Squibb reported having reached 104,000
patients worldwide through its endeavours.29▶ AstraZeneca has set out a goal to reach 50 million people (cumulative) throughinitiatives such as Healthy Heart Africa (HHA), the Young Health Programme(YHP) and the Healthy Lung Programme by 2025, as described on p.15. Notably,
AstraZeneca has already surpassed its goal, reaching over 66.4 million people
cumulatively through these initiatives as of 2023.30
Despite such a high prevalence of NCDs across LMICs in scope, these examples
show that companies’ commitments to reach patients affected vary widely in theirreach and ambition. While some companies are actively working to combat NCDs
on a large scale, others may not be as far-reaching in their initiatives. This variation
underscores the scale of the challenge and highlights the need for comprehensive
and targeted approaches. Alternatively, even if numerical targets are ambitious,
there is a noticeable lack of specificity or sub-goals in targeting individual NCDs,
hindering the effective and efficient use of resources to make a meaningful impact.
To further illustrate this analysis, goals related to one specific NCD – diabetes – areexplored in the accompanying box-out on p.22.

21

Measuring and reporting patient reach

Dominating the diabetes market: Eli Lilly, Novo Nordisk and Sanofi’s
commitments
The global insulin market is dominated by three major players: Eli Lilly,
Novo Nordisk and Sanofi, who control over 90 percent of the market
share.31 These companies have publicly committed to expanding accessto their products in LMICs, with many of these goals tied to processes
to measure and track patient reach. However, the scale of these efforts
seems limited compared to the growing burden of diabetes in thesecountries.
▶T hrough its 30x30 initiative, Eli Lilly has indicated that it aims toenhance healthcare access for 30 million people in resource-limited
settings annually by 2030, including at least 1 million people with diabetes in LMICs. The company has partnered with Egypt-based EVA
Pharma to supply affordable human and analogue insulin to at least 1
million people with type 1 and type 2 diabetes in lower-middle-income
countries, primarily in Africa. Additionally, through its partnership withLife for a Child, Eli Lilly states aiming to expand access to diabetes careand medicines to approximately 150,000 children and youth annuallyby 2030. Regarding its 30 million goal, the company reports having
reached 18 million people in 2023.12▶ Novo Nordisk asserts that its Changing Diabetes® in Children (CDiC)
programme seeks to support 100,000 vulnerable children and young
people with type 1 diabetes across 29 countries by 2030. As of 2023,
the company reports having reached 52,249 children and young people. Novo Nordisk states that its iCARE model aims to reach over 2
million vulnerable people with diabetes in sub-Saharan Africa by 2030.
For the iCARE model, the company reports having reached 433,000
people with diabetes by 2023.7▶ Sanofi, through its Global Health Unit, states aiming to provide care fortwo million people with NCDs, including diabetes, in 40 lower-income
countries by 2030. The GHU focuses on strengthening healthcare systems through initiatives like screening, diagnosis, disease management
and training. Sanofi reports having reached 261,977 patients living with
NCDs in 2023.32
Despite these efforts, these commitments collectively address only about
one percent of the diabetes (both type 1 and type 2) prevalence within
the 113 LMICs in scope of the Index, which currently stands at over 350
million cases out of the global 525 million cases, as per IHME’s GBD datafrom 2021.17 The global prevalence of diabetes is expected to increase to783 million by 2045, with a high proportion in LMICs.33
Therefore, while the leading insulin manufacturers have set out specific goals to expand access, the scale of these commitments falls shortin adequately meeting the need. As the main providers of insulin, thesecompanies are the only entities capable of ensuring access. Expanding
access through equitable pricing strategies, manufacturing partnerships
and technology transfers can be effective ways to better address thegrowing demand.

22

Access to Medicine Foundation

I N DUSTRY ANALYSIS: RE PO RTI NG

Most approaches include publicly available patientreach numbers
Overall, most of the 42 patient reach approaches have publicly available patient reach numbers thatare published either annually or on a more regular basis. Some companies demonstrated that they
were publishing these numbers for the first time. Among the 10 approaches where this is the case,some are new, which explains the first-time publication. However, for others that have been established for longer, the reason for the first-time publication is unclear.

FIGURE 9 How many approaches feature public reporting of patientreach numbers?
2 companies reported patientreach numbers for three different
approaches under an NDA

Bristol Myers Squibb, Eisai, Johnson &Jonhson, MSD, Merck, Novo Nordisk
and Sanofi have published patientreach numbers for the first time forsome of their approaches3

For 3 approaches, the resulting
patient reach numbers were notreported (either publicly or underand NDA)

342
10 approaches

26

For 62% of the approaches, regular public reporting is available● Public reporting
annually or more often● First year of public
reporting● Reporting under NDA● No reporting

Many of the companies publish their patient reach numbers in their annual reports or ESG reports(also referred to as sustainability or impact reports). Others, such as Roche and Eli Lilly, publish
their patient reach numbers directly on their websites. Several companies, including Bayer, Eli Lilly,
Novartis, Novo Nordisk and Sanofi, feature not only the most recent patient reach numbers in theirreporting but also the numbers from previous years. This is very helpful for comparison over timeand demonstrates a willingness to be transparent about how patient reach numbers have changed.
Vast majority of companies reporting patient reach numbers show improvements
Measuring progress in patient reach allows companies to track their advancements over time. This
continuous assessment ensures they can identify successes and areas for improvement, ultimately
enhancing their impact on patient access. It is worth noting that the nature of progress can vary
based on the product or programme of work. For products aimed at neglected tropical diseases(NTDs) and other infectious diseases with elimination or eradication commitments, ­simply tracking
increases in the number of patients reached may not be the most suitable method.
In the data they provided, companies were free to demonstrate improvements based on the­specific goals and objectives of their respective approaches for measuring patient reach. This
meant that, depending on the aims and targets set forth by each company, an improvement could
be either an increase or a decrease.
Of the 26 approaches with regularly and publicly reported patient reach numbers, 24 show
a clear improvement compared to the previous year. For Novartis’s measurement frameworkfor patients reached through its access approaches, a decrease from 2022 to 2023 is observed,
which Novartis explained was due to fewer patients being reached through its global health programmes. Another of Novartis’s approaches demonstrates that although the year-on-year numbers did not increase, improvements were still being made against the identified goal with a target
end date of 2025.
The fact that many companies are able to demonstrate an improvement in their patient reachnumbers is encouraging and indicates that the industry as a whole is working to enhance patient
access.
23

Measuring and reporting patient reach

KE Y FI N D I NGSCompanies are prioritising patient reach,
yet goals and approaches vary in ambitionand scope
The Foundation’s assessment of the 20 companies shows that, overall, they are
engaging in efforts to measure patient reach. While some of these approaches are
newly developed, others have evolved from the groundwork laid by companies
through access programmes and initiatives implemented in LMICs over the years.
Five findings from this assessment highlight positive developments in the industry, as well as areas needing improvement going forward.

1	19 out of 20 companies have established approaches, though only a handful
are comprehensive so far
Encouragingly, a majority of the companies have established an approach tomeasure and track the patients they reach with their essential medicines in
LMICs. This highlights that companies and their leadership recognise the importance of understanding patient reach across their operations. However, only 12
out of 42 approaches reported are comprehensive, providing detailed insights
into the equations, metrics, assumptions and limitations behind the calculations.
By having a well-defined measurement framework, companies can accurately
collect data on patient reach, measure the effectiveness of their strategies, drive
improvements and allocate resources effectively.

2	Sales volume is the primary measure of patient reach for product-focused
activities
Given their core role in the development, manufacturing and distribution ofpharmaceutical products, companies predominantly use approaches that quantify and assess the reach of their product-related activities in LMICs. Of the 42
approaches reported, 35 measure the reach of product access efforts. Sales volume divided by dosing assumptions is the main metric used in these calculations.
However, some companies have started to include additional assumptions, suchas patient adherence, indicating a shift towards more nuanced measurement
frameworks that go beyond just tracking sales.

3	Patient reach approaches vary widely in product and country coverage
Some companies focus their patient reach approaches on individual products,
while others assess reach across their entire product portfolios. Geographic
scope also varies, with some companies measuring reach in all countries where
they operate, including those within the Index’s scope, while others cover only
a subset of countries. Notably, six companies – Astellas, AstraZeneca, MSD,
Novartis, Pfizer and another company reporting under an NDA – share patientreach approaches that encompass all countries where they operate (including
those within and beyond the Index’s scope), as well as all products in scope andsome that are out of scope. Overall, the data demonstrates that across the 19
companies which reported, there are both product and geographic gaps in theapproaches used to measure patient reach. This means that in some places, andfor some diseases, the number of patients being reached is simply unknown.

24

Access to Medicine Foundation

4	Patient reach numbers are regularly published
Patient reach numbers are regularly published for most approaches. However,
10 approaches did this for the first time. This is understandable when the goalis new. But in other instances, it is less clear why public reporting has not takenplace previously. Nearly all companies that publicly disclose their patient reachnumbers also demonstrate year-on-year improvements in those numbers. This
reporting allows for assessing whether a company is effectively expanding accessto medicines for more patients. It also fosters greater accountability, ensuringthat companies remain committed to their objectives and goals of expanding
patient reach and steadily improving health outcomes.

5	Many commitments by the industry, but only a few companies set ambitious
goals to address high-burden diseases
Most companies have commitments addressing various diseases, with initiatives
ranging from improving product delivery and eradicating diseases to enhancing
access to care for specific populations, such as women and insulin-dependent
individuals in LMICs. Among the identified goals associated with patient reachapproaches, a few commitments, including those set by Johnson & Johnson,
Bayer and GSK, are clear, measurable and ambitious, with targets aligned withhigh global burdens. However, the potential for addressing high-burden diseases
means goals could be more ambitious, with ample opportunities to set higher
targets. Additionally, some goals could not be adequately measured against disease prevalence due to a lack of specificity or undefined timelines, indicating aneed for further refinement in their definition.

25

Measuring and reporting patient reach

N EX T STE PS

How can companies expand efforts tomeasure and track patient reach?
As outlined in this report, most companies have already set goals to expand thereach of their essential health products to more people in low- and middle-income
countries (LMICs) and have established approaches to track and measure their progress. Building upon these efforts, companies now have an opportunity to further
strengthen and expand their current approaches to measure patient reach, as wellas to collaborate and learn from one another. Increasing transparency and integrating patient reach goals and metrics into collaborations will help companies and theirpartners ensure that more people can benefit from the essential health products.
Complemented with actions such as product registration, implementing pricing
strategies aimed at affordability and ensuring sustainable supply, companies caneffectively reach underserved patients who are often left out.

1	Transparently and frequently report methods and results to drive
accountability, unlock new partnerships and drive impact
Companies should take additional steps to publicly disclose their patient reachapproaches overall. This includes being transparent about the underlying equation, metrics, assumptions and limitations of their measurement frameworks.
In addition, companies must continue to consistently and regularly report on
the number of patients being reached with their products and access initiatives
over time. Some companies have demonstrated full public transparency of theirpatient reach calculations and numbers, paving the way for others to follow theirlead. By being fully transparent, companies can better measure impact, pinpoint gaps and identify areas of improvement in broadening access to lifesaving
treatments.

2	
Ensure comprehensive assessment of patient reach across all products andcountries
Most companies analysed have approaches to measure and track the number ofpatients reached by their products. However, there is a need for more consistent
application of these measurement frameworks. As a first step, companies should
ensure that every product in their portfolio included within the Index’s scope, as
well as all in-scope countries where these products are sold or donated, are covered by an approach for measuring patient reach. To further build on this work,
companies should consider disaggregating and publicly reporting the number ofpatients reached per product and country. This will allow for more accurate gaps
in access to medicine to be established at a country and product level.

3	
Refine methods to fit different contexts and scenarios
Not all companies are expected to track and report patient reach figures in identical ways; nuance is essential to yield the most helpful and accurate outputs.
Companies should strive to identify metrics, equations and assumptions tailored to specific scenarios, customising methods to suit different product types,
patient demographics, treatment modalities and healthcare environments. For
example, measuring the number of patients reached with products and initiatives
across primary and secondary care settings, or estimating reach in underserved
markets, will require tailored approaches that go beyond simply tracking volumesof products sold or delivered. By considering different scenarios and tailoring

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metrics accordingly, companies can establish the most effective denominators,
assumptions and principles over time, ultimately enhancing the precision andrelevance of their approaches to achieve more accurate patient reach numbers.
This approach could also help move towards more standardised approaches
across the industry, aligned with specific scenarios.

4	Work with partners to collate and track more granular, on-the-ground data
for monitoring patient reach so efforts can be expanded
A few companies analysed are working with partners to gather on-the-groundinformation regarding their patient reach. This helps companies understandwhich populations are being reached with each product and facilitates broader
integration of these practices throughout the supply chain. From the outset,
companies and their partners should establish specific activities to measure,report and improve patient reach. For example, by incorporating processes tocollect and report patient reach data within partnership contracts and agreements, companies can better track patient reach beyond the point of delivery
and demonstrate their impact on underserved and harder-to-reach patient
populations.

5	When establishing patient reach goals and approaches, consider prevalence,disease burden and the number of treatment-eligible patients
When setting patient reach goals, companies should integrate factors such as
disease burden in LMICs, the number of treatment-eligible patients and the competitive landscape. These considerations are crucial for establishing clear, measurable objectives that are both ambitious and achievable. By incorporating thesefactors, companies can set goals that provide direction and facilitate effective
monitoring. Establishing defined timelines allows for objective progress tracking, while breaking down objectives into specific, manageable sub-goals helps
develop targeted interventions. This structured approach ensures that the goals
are not only well-defined but also actionable and impactful, leading to meaningful improvements in expanding access to essential treatments in underserved
regions.

6	Drive progress by collaborating and sharing knowledge with industry peers
To drive progress in patient reach measurement, companies can collaborate andharmonise the types of assumptions, equations and metrics that have proveneffective in tracking and measuring the reach of particular products across various settings. This will not only facilitate greater consistency in patient reachmeasurement frameworks across the industry, but also standardise reporting
to appeal to investors and other stakeholders. While certain elements may needtailoring to specific contexts and products, companies can contribute case studies that highlight the challenges faced, lessons learned and the impact of theirrefined patient reach measurement strategies on informing decisions aroundtheir access in LMICs.

7	
Take action towards improving patient reach approaches while prioritisingaffordability and accessCompanies should prioritise measuring and tracking patient reach throughrobust approaches, but they also need to ensure they are focusing on the accessand affordability of products. This way, while they have effective methods tomeasure patient reach, they are simultaneously expanding it for true impact.
To overcome barriers that restrict products from reaching patients, companies should implement strategies such as equitable pricing and initiatives tostrengthen local healthcare capacity and supply chains, all while collaboratingwith partners.

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Measuring and reporting patient reach

D E FI N ITI O NS
Access strategies
The range of mechanisms a company can implement to provide accessto its product for a specific group of patients within a country. An accessstrategy can be composed of different elements, including pricing strategies and additional initiatives to improve the affordability and availability of the product. Access strategies with the biggest potential impact interms of equitable access are those that aim to promote affordable accessto medicine for all income groups of the population by considering the ability to pay of the payer, and by taking healthcare systems’ needs and characteristics into account.
Equitable pricing strategy
A targeted pricing strategy which aims to improve access to medicine forthose in need by considering the relevant payer’s ability to pay, and by
taking healthcare systems’ needs and characteristics into account.
Patient assistance programmes
Programmes initiated by pharmaceutical companies which provide financial assistance or free-of-charge medicines for a defined patient population
with limited ability to pay.
Patient reach
The number of people benefitting from access to a company’s product(s),which can be demonstrated through, for example, annual sales volume
divided by volume per patient, or the estimated number of patientsreached by a particular access strategy, initiative, or partnership. The Indexevaluates a company’s overall process for defining, measuring, and reporting on patient reach, as well product-specific examples of patient reach inthe context of access strategies.
Prevalence (expressed as a proportion)
The total number of cases of a given cause in a specified population at adesignated time. All results in GBD refer to point prevalence.34
Sustainability-linked bond
Sustainability-linked bonds (SLBs) provide financing to issuers who commit
to specific improvements in sustainability outcomes. These outcomes may
be defined as environmental, social and/or governance related.35
Vulnerable populations
People at greater risk of facing barriers to accessing medicines due tosocial, economic and/or health considerations.

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Access to Medicine Foundation

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