Pharma companies can have an “emerging markets strategy”

Emerging markets are nothing like one another: an Argentinian denied an expensive new drug will usually just go and get a court to order his insurer or the state to pay for it; an Indonesian may never even find out what’s wrong with him.  Argentina spends about $1050 per person on health every year; Indonesia about $105. There are constant surprises: South Africa spends about as much per head as does free-riding Saudi Arabia, for example. You do need to coordinate, though because of reference pricing and coordinated cost controls.

Too see more about per capita spending on health in developing and emerging markets, look at this overview on our site. It has links to data as well.

Companies can decide whether they want to introduce medicines into emerging markets

You hear lots of brave words about intellectual property but access to medicines is mostly about politics. Politically speaking, breakthrough medicines have to be available to (at least some) people in all big  emerging markets. The only choice you really get to make is about the sequence in which you introduce and about how aggressive you are in offering innovative access. If you fail to introduce — or you stick Bayer-like to the view that access and affordability is not your problem — expect illicitly-imported generics in China and illegal generics or even loss of IP in India. And hope that your CEO has a thick skin when a South African minister accuses him or her of genocide. No government in Europe or North America will do much to help you, whatever blustering they do in the media.

Too see more about Bayer’s experience in India and other compulsory licensing stories, click here for a 2013 article on our site  or contact us for a list of related articles on this site and elsewhere.

A company can let each subsidiary decide on the best course

We live in a world where you can Google my videos on YouTube (a hint: I’m not the Mark Chataway who does exciting 3D animation) so you can certainly find out what Russia is doing about introducing new health technology assessment (HTA) mechanisms. The problem is, so can insurers and reimbursers in every other market

• Colombia is now reacting strongly to the realisation that it was often paying 30 or 40 percent more for therapeutics than EU countries were and 50 or 60 percent more than Argentina was
• Indonesia and Roche have agreed some very low prices in the Indonesian public health system but you’ll search in vain for anything about it on any Roche global websites. An oncologist told us the outline and a researcher who spoke Bahasa Indonesia got details of the prices in a few days

Click here for an article by Colombia’s health minister in the bulletin of the International Monetary Fund

Universal health coverage and a growing private insurance market are both good news for innovation

You will read a lot about the rapid rise of private insurance coverage in China and bullish reports about India. These policies often have low lifetime cash payout limits or act more as savings plans than as true insurance. From Indonesia to Mexico to Turkey, many feel that the insurers are quick to sell but reluctant to pay out. In a lot of markets, the rate-limiting issue is not who will pay but who will diagnose or manage treatment — if eighty percent of cases of cancer are not diagnosed until the patient has end-stage metastatic disease, it doesn’t really matter who pays for treatment.

In most emerging markets, confidence in the private sector is low. Chinese patients would much rather face queues and indifference to get to a top-tier state institution than trust a private clinic which may or may not have the right skills and may recommend what is profitable rather than what is justified.

A few universal health schemes are ambitious; most are designed to offer pretty basic care with old drugs. They can, though, be a basis for innovative access

The solution is local manufacture and investment

Yes but a company can’t build plants everywhere, much less R&D centres. Many emerging markets also want other interesting models for access

• Gilead’s deal with Egypt on hepatitis C treatment is compelling: Egypt promised hundreds of thousands of patients within a year (and an anti-diversion mechanism) and Gilead offered a price for branded product that is about 90 percent lower than its US list price. It’s mostly working and, so far, no-one has used it as a reference price
• India has slashed the price of cardiovascular surgery (and got better outcomes than Western Europe) by introducing a production line; a similar revolutionary approach may see experts planning cancer care but non-specialist centres delivering much of it with specialist advice coming only through telemedicine links
• Brazil has a couple of fascinating capitation pilots in diabetes with pharma companies
• South Africa wants to deal with multinationals over access to medicines in return for genomic data from the new national health insurance scheme

If a company is left out of these innovations, it will be taken by surprise when they come to Europe and North America

We do not do any access work for any of the companies named in this article

Mark Chataway taking part in an Indian Federation of Chambers of Commerce and Industry (FICCI) forum in 2014