Pharmaceutical Executive Europe - November/December 2007 - (Page 30) 30 World Health Nov/Dec 2007 Pharmaceutical Executive Europe There is no doubt that companies would reach a much larger volume of customers in emerging markets by identifying creative access strategies such as this. Engaging governments in a dialogue around specific diseases is key in developing countries. Companies should reach out to key opinion leaders in governments and in academia and work with them to raise awareness amongst healthcare providers and the THE THREE-STEP APPROACH Building a strategy for doing business with developing countries, using an evidence-based market segmentation that takes into account patient income and purchasing power, requires a validated three-step approach. First, the application of an affordability model that uses a unique mixture of statistical methods, income data, disease epidemiology, public health principles and in-depth knowledge of health infrastructure barriers to calculate what proportion of the population would be able to access a given drug at various price levels. The shape of the price/volume or cost/volume curve varies greatly based on country income and purchasing power. Figure 2 shows the percentage of the population that is able to afford a certain price/cost level in three countries with different levels of income. The second step is to determine the strategies and operations to implement the approach. For instance, if a drug will be made available to three different income groups of patients at three different levels of cost to the patient, there needs to be a strategy of price discounting or nonprice discounting that allows all patients of the population to access the drug. This approach is easier than it appears and public health organizations are accustomed to segmenting populations for the delivery of public health interventions. Strategic considerations include keeping the list price, how to determine income levels of patients and how to operationalize this assessment, how to involve an existing distributor networks, customs and tax considerations and so on. The third step consists of reaching out to the government and key stakeholders in the countries. The reduction in cost to the end-user should be used to build a closer relationship with the governments and key opinion leaders and to become a partner in providing access to patients in a given disease area. Such activities may include raising public awareness or training health professionals. It may also result in collaborations with the government on how and under which circumstances a given drug can be accepted for the national reimbursement list. The picture may be different in each country but the three steps in the strategy are applicable to most developing countries. public about a given disease. In parallel, it is critical to segment the market and determine appropriate cost levels based on affordability as well as the coverage of third party payers, such as social security and private health insurances. In short, pharma companies cannot conduct “business as usual” in emerging economies — they should consider taking a new approach that combines public health concerns, relationship building with governments and creative commercial strategies that make their products available to different segments of the population according to affordability. It would be useful to use the lessons from the HIV years, and create a win/win situation for governments, patients and companies. ■ References 1. In December 2005, members of the World Trade Organization (WTO) approved measures to make it easier for poorer countries to obtain cheaper generic versions of patented medicines. The decision transformed the 30 August 2003 ‘waiver’ into a permanent amendment of the WTO Agreement on TRIPS. The waiver sets aside a provision of the TRIPS Agreement that could hinder exports of pharmaceuticals manufactured under compulsory licences to countries that are unable to produce them. 2. http://news.bbc.co.uk/2/hi/africa/1285645 About the Authors Dr Anne Reeler is a medical anthropologist with 20 years’ experience in design and implementation of programmes to improve access to drugs and health care in developing countries. Her experience spans different organizations including the World Health Organization, UNAIDS, The Economic and Social Commission for Asia and the Pacific as well as research projects in the field. She is a co-founder and chief technical officer of Axios International (France). Dr Joseph Saba, CEO and co-founder of Axios, is an expert on clinical research and health access programmes in developing countries. A medical doctor specializing in infectious disease, health management and statistics, Dr Saba has previously worked with the World Health Organization’s global programme on AIDS and UNAIDS. He and the Axios team advise pharma industry clients on strategies, programme design, operations and strategic communication related to creative drug access strategies for developing and emerging countries. http://news.independent.co.uk/business/news/article255418.ece
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