By Elizabeth Hampson, Director Monitor Deloitte

Today, over a quarter of the world’s population has no access to essential medicines and, for more than two billion people worldwide, medicines may be unaffordable, unavailable, inaccessible or non-quality assured.^{1 2} With statistics this stark, and the increased awareness (due to the COVID-19 pandemic) of the impact of both global and national health inequalities on health outcomes, there is a need for much better awareness and more targeted action to improve access to medicine for all.

Access and affordability programmes (AAP) are initiatives that aim to provide equitable and sustainable access to medicines and health care around the world. For several years now Deloitte have been keeping track of the global access and affordability programmes being run by major pharma companies. We now have a database of over 400 programmes delivered by more than 20 pharma companies to enable us to understand the trends, requirements and ecosystem partners needed to deliver a successful programme. In November 2021 we published a report on the insights derived from this proprietary Deloitte Access and Affordability Database and our experience in supporting pharma companies in understanding and addressing the challenges to, and solutions for, improving access. This blog provides an overview of our findings.³

Categorisation and mapping of AAPs

After 2008, there was a notable growth in AAPs including a shift from AAPs targeted primarily at giving back (those with no clear commercial link to a company’s business model) to those with a more strategic vision. These strategic programmes aligned with the pharma company’s commercial strategy can be used to create a competitive advantage over time, as opposed to being solely a charitable endeavour. We have also seen big leaps in the number of programmes at certain times for example when the Millennium Development Goals and Sustainable Development Goals were launched in 2000 and 2015 respectively. This was also seen when large collective private and not-for-profit endeavours to tackle medicines inequalities in low-income countries such as Medicines Patent Pool was launched in 2010 and Access Accelerated in 2017, showing a connection to growing global awareness of corporate social responsibility initiatives on a company’s reputation.

AAPs often need to overcome numerous barriers to improve patient access. These barriers differ widely across different markets, both in relation to the type of healthcare system and therapy area. Despite these differences, AAPs are largely designed to overcome the following barriers (see Figure 1):

• Affordability – a focus on reducing price. Activities that lower medicine acquisition cost, either for the patient or the payer.
• Awareness – a focus on supporting the patient. Non-price focused activities providing support directly to increase patient engagement with HCPs or medicines adoption and compliance.
• Accessibility – a focus on improving equity within the health system. Activities that strengthen health care systems by building capacity and capability to enhance diagnosis, infrastructure treatment or patient management.

Figure 1. AAP are designed to overcome barriers due to affordability, awareness and accessibility

Source: Deloitte analysis

Across these three categories there are a wide range of activities or levers employed by pharma companies with the goal of improving patient health and achieving universal access. We have developed a framework to help pharma companies think about AAPs across 12 key dimensions and track the wide range of initiatives used (see Figure 2).

Figure 2. The 12 levers typically employed by pharma companies across AAP categories

Designing effective solutions

Patient access to medicines and health care is driven largely by how well-funded the health care system is, the level of disease awareness and education of the community, as well as the extent to which patients need to bear the financial cost themselves. When designing AAPs, pharma companies must consider the markets they are intended for, and the challenges facing patients within them.

There are many disruptive forces across health care and life sciences that are transforming industry dynamics (such as new players coming into health, growing patient engagement in their own care and an emergence of more real-time health data) and these are changing the AAP strategies used by pharma companies. The advantage of our database is that we can track trends over time and see how AAPs are evolving. We see four key trends developing:

1. AAPs are becoming more holistic: An approach that combines price, patient and system levers provides more opportunities to overcome barriers to access. We find that many AAPs combine multiple activities in a single programme and our database shows that while on average 27 per cent focus on a system lever, 21 per cent on price and 10 per cent on the patient; the majority (around 40 per cent) focus on more than one lever. By 2020, the proportion of AAPs using multiple levers had increased to 45 per cent and we expect this proportion to increase further still as post-pandemic initiatives are included in the dataset.
2. Partnerships are becoming increasingly important: Cross pharma public collaborations (between governments, NGOs, global health agencies etcetera) are crucial in helping to tackle multiple access barriers within a single programme. A collaborative approach can improve effectiveness through combining the expertise of different organisations to understand the barriers to access and can help extend outreach to broader patient populations.
3. The adoption of digitally enabled AAPs is accelerating: The adoption of technology is advancing rapidly, and this has been further accelerated by the pandemic. Increasingly AAPs are utilising technology-led solutions to support patients. Of the AAPs identified in 2020, approximately twenty per cent used some form of digital technology, a doubling from the average during 2010-2019 and a five-fold increase from the 2000-2009 average. Some examples we have seen in recent programmes cover both patient and system dimensions, including: HCP training through e-learning; smartphone apps being used to monitor symptoms; telehealth advice and support programmes; and tech-led financial support programmes.
4. The focus is shifting increasingly to disease prevention and early interventions: Over the past decade approximately 23 per cent of AAPs have focused on supporting diagnosis of disease in order to improve outcomes through various activities such as: improving access to diagnostic tools; increasing diagnostic capacity in health care systems; and setting up patient engagement clinics. This has been particularly important during the pandemic as many patients have missed screenings or been reluctant to access or prevented from accessing health care support and advice to discuss symptoms, particularly in oncology.

COVID-19 has exacerbated the challenge of providing access to medicines and health care which is now more pervasive than ever. This challenge is likely to grow as more innovative and expensive medicines come to market, for example, cell and gene or personalised therapies. Based on our experience and insights we envisage that, over the next five to ten years, innovation in AAP design will help pharma keep pace with industry trends and respond to changes within the health care ecosystem. We predict that the most successful AAPs will be those that:

• are developed collaboratively with multiple partners
• utilise data analytics and digital to drive tailored and efficient solutions to overcome access barriers
• focus on what is needed to strengthen health system resilience.

We consider that in the future AAPs will be increasingly important for patients, health systems and companies. There will also be greater visibility on what pharma companies are doing to deliver outcomes and improve access for patients to reduce health inequalities, promoting greater investment, visibility and transparency across the industry.

Elizabeth Hampson, Director, Monitor Deloitte

Liz is a Director in Monitor Deloitte. She leads projects that accelerate patient access to innovation, which includes health policy advisory and strategy projects with central government, industry, charities and payers in a range of countries. She is also a mental health champion.

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¹ https://www.who.int/publications/m/item/access-to-medicines-making-market-forces-serve-the-poor

² https://academic.oup.com/heapol/article/34/Supplement_3/iii1/5670624

³ https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/life-sciences-health-care/deloitte-uk-access-and-affordability-programmes.pdf