Introduction
Access to medicines in low-income markets remains a significant challenge, exacerbated by pricing pressures and high drug development costs. Populations in these regions often face limited access to essential treatments, worsening health inequalities. As pharmaceutical companies strive to balance profitability with social responsibility, it becomes imperative to rethink commercial strategies and reduce drug development costs.
On one hand, the dynamics of pricing pressures directly impact access to medicines. On the other hand, innovative approaches to reducing development costs can significantly improve accessibility in low-income markets. By reevaluating these aspects, we can identify sustainable solutions to make healthcare more affordable and equitable.
Rethinking commercial strategies
- Innovative pricing models
The traditional pharmaceutical pricing model of maximizing returns during patent protection is misaligned with broad, equitable access to affordable medicines globally. As outlined by Szymański et al. in the 2021 article in BMC Pediatrics on lung ultrasound for predicting respiratory support needs, innovative pricing strategies like subscriptions and outcomes-based agreements can improve accessibility and adherence by linking costs more directly to downstream patient value [1].
A subscription model involves charging a flat periodic fee for continued access to a medicine, like software or media services.
This creates stable revenue streams for manufacturers while offering steep discounts or unlimited use for patients in exchange for long-term loyalty. Outcomes-based pricing only charges full price if the drug achieves pre-defined therapeutic goals or metrics in real-world settings.
Both approaches help decouple drug development costs from pricing and shift focus to the actual value delivered for patients’ post-approval.
The lung ultrasound scoring study published in BMC Pediatrics demonstrates how such pricing innovations could promote more equitable access to respiratory therapies like surfactants.
For example, offering neonatal intensive care units a subscription to surfactant could lower premature infant mortality by removing upfront cost barriers to optimal treatment. Paying the full surfactant price only if oxygenation targets are met would incentivize manufacturers to ensure maximal post-approval efficacy.
In summary, creative pricing schemes that share financial risk, limit irrational prescribing, and tie costs to real-world performance offer paths to making novel respiratory and other medicines more accessible globally, especially in lower-income markets. However, they require pharma companies to fundamentally rethink traditional revenue maximization approaches.
- Leveraging digital technologies to improve access
While innovative pricing schemes aim to improve affordability, leveraging digital technologies presents opportunities to transform pharma business models and enhance equitable access globally.
As discussed by Lin et al., rural and low-income populations can face barriers to accessing affordable treatments, such as high costs and limited healthcare infrastructure. To address these access gaps, the authors recommend leveraging digital technologies like telemedicine and mobile health tools [2].
Building on this, pharmaceutical companies have opportunities to transform business models using creative digital strategies focused on improving equitable access globally. For instance, telemedicine platforms and mobile health apps can extend care to hard-to-reach demographics. Digital diagnostics enable remote expert support for local healthcare workers.
Additionally, AI, blockchain and advanced analytics can optimize supply chains to prevent shortages and ensure drug availability.
By developing human-centered digital solutions focused on access rather than sales volume alone, pharma leaders can align commercial models with affordable and equitable healthcare delivery.
While leveraging technology to enhance access is crucial, rethinking the costly drug development process itself also presents opportunities to improve availability and affordability.
Rethinking drug development costs
- Collaborative R&D
The study conducted by Addazio et al. in 2021 highlighted significant barriers people with disabilities face accessing dental care. It revealed that in Italy, only 69.2% of dentists reported treating these patients, with many citing lack of accessibility and training as barriers [3]. Nearly half of disabled patients said they only access dental care when emergencies arise.
While this study was limited to Italy, the access barriers it exposed reflect broader trends documented globally.
Research indicates 35-50% of those with disabilities worldwide lack access to needed dental care according to a WHO report [4]. Challenges like inaccessible office facilities, insufficient provider training, and lack of regular follow-up prevent many from obtaining routine preventive dental treatment.
Addazio highlighted strategies such as specialized dentist training, improved office accessibility, assistive technologies, and regular follow-ups that could help overcome these gaps. Their findings reinforce the substantial improvements in training and availability of routine dental care may be essential to ensuring people with disabilities have equitable access to oral healthcare.
Changes are needed at multiple levels. In terms of training, expanded continuing education on disability needs would increase provider awareness. Financially, assistance programs for uninsured patients would reduce economic barriers. Systemically, enhanced care coordination during pediatric to adult transitions would prevent lapses in care.
- Publicly Funded trials for affordable drug dev
Publicly funded clinical trials could help spur development of affordable new drugs.
As Kim et al. highlight in their review on vaccine herd effects, publicly funded trials have played a key historical role in generating evidence on vaccine efficacy and indirect benefits that facilitated widespread adoption [5].
For example, large publicly funded trials demonstrated the significant herd effects of the monovalent meningococcal serogroup C vaccine in the UK in preventing carriage and disease in unvaccinated groups. Public investment in additional large clinical trials could provide needed evidence to support new drug approvals and expanded use.
However, care must be taken to ensure responsible public stewardship and equitable pricing.
As Kim et al. note, herd protection from initial vaccination programs can decrease over time if not sustained. Ongoing public health surveillance and continued trials may be warranted after initial approval to support appropriate use.
Overall, judicious public investment in trials can catalyze development of therapies but must be balanced with mechanisms to ensure affordable pricing and sustained public health benefit.
Conclusion
To conclude, improving equitable access to affordable medicines requires rethinking both pharmaceutical commercial strategies and drug development processes. Adopting innovative value-based pricing models, leveraging digital technologies, investing in collaborative R&D, and funding public clinical trials are among the key approaches.
To move forward, a mindset shift is needed from short-term profit maximization to sustainable models focused on accessibility and public health service. Though complex, this joint effort across public and private sectors is essential to advance health equity and social justice globally.
[1] Modified lung ultrasound score predicts ventilation requirements in neonatal respiratory distress syndrome - PMC (nih.gov)
[2] Frontiers | Simiao Decoction Alleviates Gouty Arthritis by Modulating Proinflammatory Cytokines and the Gut Ecosystem (frontiersin.org)
[3] IJERPH | Free Full-Text | Access to Dental Care—A Survey from Dentists, People with Disabilities and Caregivers (mdpi.com)
[4] Disability (who.int)
