Program Profile

Access and Affordability Initiative (AAI)

Working with the Bill & Melinda Gates Foundation, MSD, Pfizer, Novartis and Sanofi, created the Access and Affordability Initiative. This initiative worked with the governments of Ghana and the Philippines to implement differential pricing pilot programs to make innovative medicines more affordable to low- and middle-income patients.

For both Ghana and Philippines, the key objective was to determine whether differential pricing of selected innovative medicines improved the uptake of medicines and the control of the two chronic diseases, hypertension and diabetes.

For Ghana, the objective was to assess whether the use of differential pricing and improving the availability and affordability of quality, safe and efficacious medicines contribute to improved access to medicines. This specifically targeted underserved population who currently had limited or no access to innovative medicines that had not been included on Essential Medicine List for the management of hypertension and diabetes.

For the Philippines, the objective was to determine whether the use of differential pricing, in combination with health systems strengthening, is associated with improvements in health service utilization, quality of care, affordability of and access to medications, and health outcomes.

The Province of Palawan was selected as the study location because it is underserved, with comparatively poor health indicators as compared to other areas of the Philippines. It is also diverse, including urban areas and remote islands and was considered representative of various environments and access challenges common in the Philippines.

While the research objectives of the Ghana and Philippines studies were similar, contextual factors necessitated different study designs in each location. These factors were integrated in each research design.

To determine whether the use of differential pricing in combination with health systems strengthening improvements is associated with improvements in health service utilization, quality of care, affordability of and access to medicines, and health outcomes. ,

Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide, and the poorest and most vulnerable are most affected by these largely preventable diseases.

Having access to medicines to combat NCDs is a key factor for improving health and development in communities. Diseases, such as hypertension and diabetes together, affect more than 1 billion people in LMICs.

The Access and Affordability Initiative (AAI) was a health collaboration between four pharmaceutical companies, MSD, Novartis, Pfizer and Sanofi, and the Gates Foundation. The Initiative examined the role of differential pricing and health system strengthening to help improve access to medicines for underserved populations, particularly low-income groups, in LMICs.

The AAI pilot programs explored an innovative approach, which measured the ability of patients living with NCDs, specifically hypertension and diabetes, in the same country to access innovative medicines for these conditions when differential pricing is applied. The AAI pilot programs in Ghana and the Philippines constituted the first multi-stakeholder, private sector effort to partner with governments with the explicit goal of validating intra- country differential pricing as a sustainable access tool.

Approximately 3,000 people were enrolled in each study, which were unique in incorporating supplementary health system strengthening efforts. Studies included training of healthcare professionals in the treatment of hypertension and diabetes, including improvements in clinical management and patient monitoring, supply chain solutions to ensure medicines availability, differentially priced medicines for individuals determined to be lower income according to study criteria and the provision of clinically-appropriate patient care.

Consistent with anti-trust laws that govern industry interactions, each participating company independently and voluntarily developed its own marketing and pricing strategies reflecting, among other factors, the Company’s product portfolios and the patients it serves. Accordingly, each of the participating companies independently and unilaterally made decisions involving the AAI.

Differential pricing is a system that enables people to pay according to their means. To date, studies have mainly focused on measuring the impact of differential pricing between countries. The AAI pilot programs exploredan innovative approach which measures the ability of patients living with NCDs in the same country to access medicines for these conditions when differential pricing is applied. The program comprised two pilot projects in Ghana and the Philippines, with around 3,000 people enrolled in each pilot.

MSD, Novartis, Pfizer and Sanofi contributed financial support and project design consultation as well as differential pricing of medicines for use in the pilots. The Bill and Melinda Gates Foundation contributed financial support for the development and implementation of evaluation programs for the two pilot projects, which was led by the Johns Hopkins Bloomberg School of Public Health.

The AAI is one of the initiatives supporting Access Accelerated, a global partnership of a coalition of biopharmaceutical companies to address the barriers to access for NCDs in LMICs.

*MSD is known as Merck & Co., Inc. in the United States & Canada

The pilot project reinforced health system strengthening, resulting in the delivery of quality health services to patients where and when they need them. It provided for capacity-building for healthcare providers to enhance patient adherence, clinical management, and supply chain management. The project also helped build reliable information for decision-making through the patient registries and the use of Electronic Medical Records (EMRs).

The project enabled increased access to DP medicines for hypertension and diabetes. It ensured the uninterrupted supply of quality medicines with the strict adherence to Good Distribution Practice for pharmaceuticals.

The project enhanced the utilization of health services by integrating patient education and empowerment: enrolled patients were provided health information on disease prevention, management and control, and nurses sent SMS to patients to remind them about check-ups and prescription refills.

Patients' health indicators also showed improvement. Specifically, diabetic patients taking differentially-priced (DP) medicines showed a decline in their HbA1c level. A decrease in blood pressure among hypertensive patients on DP medicines was likewise noted.

The data for this program has been reviewed by both the companies and the Access Observatory team.