Conceptualisation and Role of Market Access in Pharmaceutical Industry: A Scoping Review
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Inductive Analysis of the Included Studies
3.1.1. Right Products
3.1.2. Right Patient
3.1.3. Right Point
3.1.4. Right Price
3.1.5. Right Place
4. Discussion
MA in pharma concerns providing the right products for the right patients, delivered at the right point in time, within the right place or setting, and at the right price.
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Authors, Year | Study’s Methodology | How Is MA Conceptualised? | How Is MA Defined? | Type of Pharmaceutical Product | MA Strategy | Setting | Country of Study | Disease Areas |
---|---|---|---|---|---|---|---|---|
Africa Region | ||||||||
Ameh et al. [19] | Study design—Community-based qualitative studies Sample size—FGD (N = 155), IDI (N = 25), and KII (N = 11) | Access to health care products and reducing health inequalities | Ensuring access for patients through the 4 As—availability, accessibility, affordability, and acceptability | Drug | Access | Community | Nigeria, Kenya, and Tanzania | N/A |
Larson et al. [20] | Study design—Longitudinal survey of ADDO Sample size—356 ADDOs | Prescription of medicine relating to uptake of pharmaceutical products and hence market adoption of new pharmaceutical product | Stocking of new products will lead to local demand for effective products | Drug | Access | Community | Tanzania | Malaria |
Rutta et al. [21] | Study design—Retrospective analysis of ADDO model Sample size—448 ADDO dispensers | Access to Artemisinin-based combination therapy (ACT) drugs for patients | Accredited Drug Dispensing Outlet (ADDO) programs were used to ensure access for patients | Drug | Access | Community | Tanzania | Malaria |
Vialle-Valentin et al. [32] | Study design—Secondary data analysis Sample size—1267 individuals | Access and affordability | Development of national policies to improve health care finance system to avoid catastrophic health cost | Drug | Access | NA | Low-income countries, with Rwandan experience | N/A |
America Region | ||||||||
Schmittdiel et al. [27] | Study design—Cross-sectional Survey Sample size—1458 Medicare beneficiaries with diabetes | How the cost of drugs can affect access and medication adherence | Physicians switched patients’ drugs from high-cost drugs to low-cost drugs considering patients’ out-of-pocket costs | Drug | Cost and adherence of drugs | Community | USA | Diabetes |
Simon et al. [28] | Study design—Qualitative study Sample size—IDI (N = 24) | Computerised order entry (CPOE) to ensure safety, quality, and efficiency for patients. | Hospitals in USA rapidly adopted CPOE to reduce errors with medicines and to ensure safety and efficacy | Drug | Safety and efficacy | Hospital | USA | N/A |
Asia Region | ||||||||
Patouillard et al. [29] | Study design—Qualitative study Sample size—38 sub-districts Each sub-district provides PHC services to around 10,000 inhabitants. | Access to pharmaceutical products free from the government-owned outlets, including health centres and hospitals | Using economic perspective, 3 categories of MA was established to determine product price: (1) Accessible market—less than 2.5 h, (2) moderately accessible market—2.5—4.5 h, and (3) remote market—more than 4.5 h | Drug | Access | Community | Cambodia | Malaria |
Waning et al. [30] | Study design—Secondary data analysis Sample size—N = 162,999 data | Affordability of medicine | The Kyrgyz ministry of health changed the law in 2005 to let nurses fill prescriptions with chemists in rural areas after completing 2-week training program | Drug | Access | Hospital | Kyrgyzstan—Central Asia | N/A |
Europe Region | ||||||||
Lordatti et al. [23] | Study design—Mixed method Sample size—NA | Efficacy, safety, access, and ease of use | Physicians to develop their own ideas about the value of new drugs based on efficacy and safety | Drug | Access | Hospital | France | N/A |
Hughes-Wilson W. et al. [22] | Study design—Secondary data analysis Sample size—NA | Access to orphan drugs for patients | These should include rarity, disease severity, the availability of other alternatives (level of unmet medical need), and the level of impact on the condition that the new treatment offers | Drug | Access | Global | Europe | N/A |
Rollet et al. [24] | Study design—Secondary data analysis Sample size—NA | Access to orphan medicinal products (OMPs) | Cost of manufacturing should determine the fair price of OMPs. High-priced OMPs exacerbate affordability problem for health care budget | Drug | Access | Global | Italy, Spain, and Germany | Oncology—Cancer |
Romao et al. [25] | Study design—observational, cross-sectional, multicentre study Sample size—185 pharmacies; 412 people | Access to pharmaceutical products and patients having relationship with pharmacist | In 2017, the government enacted a law to improve the control of and equitable access to pharmaceutical products | Medical device | Access | Community | Portugal | Ostomy patients |
Unspecified | ||||||||
Lee et al. [31] | Study design—Narrative review Sample size—NA | Pharmaceutical price setting for countries with low income to ensure uptake of pharmaceutical products | Designed to know how prices of drugs are determined. The pricing trends of their analysis explain why low-income countries are paying the lowest originator price, followed by lower-middle-income and upper-middle-income countries. | Drug | Access | Global | N/A | HIV |
Miller et al. [26] | Study design—Retrospective data analysis Sample size—398 programmes | Expand access to ensure uptake of pharmaceutical products | Allow physicians to prescribe medicinal experimental therapy unapproved by the USA Food and Drug Administration (FDA) to terminally ill patients—this law is now approved in 36 states so as to ensure access. | Drug | Access | Hospital | N/A | HIV, leukaemia, and multiple myeloma |
Authors’, Year | Key Findings | Implications | How MA Is Conceptualised |
---|---|---|---|
Ameh et al. [19] | Patients having free health services and insurance had better access to pharmaceutical products (PP). However, patient medicine vendors (PMV) were perceived to be more affordable/accessible than those provided by health providers. PMV were also flexible with instalment payment for service fee. | The cost of pharmaceutical products is an important consideration in ensuring access to PP. Also, proper regulation of PMV improves the patient’s access to the PP. Hence, there is a need for policy and programmatic actions to regulate PMV to ensure safety and access to PP for patients. | MA is conceptualized in terms of affordability (right price) and availability of PP at the right context or place using free health services, insurance schemes, and PMVs. |
Hughes-Wilson W. et al. [22] | Patients’ access to orphan drugs and availability of other alternative medication and new treatments for rare and severe diseases to meet unmet medical needs. | Increasing budget on orphan drugs will improve availability and affordability of product for the indicated patients for which the orphan drugs are produced. | MA is conceptualised in terms of right product (orphan drugs) at an affordable cost (right price) for the right patients (rare disease). |
Lordatti et al. [23] | Giving physicians information about new PP improves knowledge of benefits, contra-indication, and use of the product to ensure safety, access, and efficiency of the PP. | Training of health care professionals such as physicians on the use of new PP in order to improve better patient access as well as ensure safety and efficacy for the patients using the new drug introduced. | MA is conceptualized in terms of the availability (right product) of a new product at the right point (following MAu) through the right setting/medium (physicians). |
Larson et al. [20] | Stocking wholesalers with higher numbers of proximal shops and clinics, larger customer traffic, and the presence of a licensed pharmacist in densely populated areas with subsidized anti-malarial drugs (ACT) rather than having isolated shops that serve fewer customers played a major role in expanding PP availability. | Empowering wholesalers with higher market competition and customer demand metrics with the right and subsidized resources to stock PP ensures better access for patients in developing country markets. Healthcare providers work with wholesalers to ensure access to PP for the patients. | MA is conceptualized in terms of the availability (right product) and affordability of PP (right price) supplied through high-profile shops in competitive markets and wholesale suppliers to ensure faster product diffusion across all drug retailers (right place). |
Lee et al. [31] | Sub-Saharan Africa (SSA) (excluding South Africa) pays the lowest price for antiretroviral drugs. East Asia and the Pacific and South Asia were pays 10% less than SSA. Lower-, middle-, and upper-middle-income countries pay higher costs for PP. Also, availability of child-friendly type of formulation of drugs played a major role in the uptake of PP. | Pharmaceutical industries’ innovative incentives based on geographical considerations as well as product available based on age demographics improve uptake of products and better patient access. | MA is conceptualized in terms of the availability (right product) and affordability of PP (right price) based on geographical considerations (right place). |
Miller et al. [26] | Benefits, limitations, and ethical and regulatory implications of programmes involving expanded access and compassionate use of experimental therapies to terminally ill patients as well as the proportion of such programmes that ultimately received MAu were highlighted. | Allowing healthcare providers to use safe and efficacious drugs not yet approved by regulatory bodies like FDA in America might promote better access to PP by patients. | MA is conceptualized in terms of the availability (right product) of PP using expanded and compassionate access programmes for terminally ill patients (right patient). |
Patouillard et al. [29] | Price mark-ups, which are influenced by several contextual factors as well as other key elements of anti-malarial supply and demand, play an important role in the limited access to appropriate anti-malarial drugs in retail outlets in Cambodia. | Reducing the cost of medications and regulating price mark-ups by printing the price of the product on the pack may translate to better patient access and reduce out-of-pocket expenses. | MA is conceptualized in terms of availability (right product) and affordability (right price) as well as consideration for the economic context/setting (right place). |
Rollet et al [24] | Publicly available national statistics showed that the budget impact of orphan medicinal products (OMPs) is low due to small population size and might plateau in 5 years’ time. OMPs are mostly for oncology treatment. | Increasing the budget on OMPs will help with access and affordability for the patients to the orphan drugs that are produced. | MA is conceptualized in terms of availability (right product) and affordability (right price) of orphan medicinal products for the right patient. |
Romao et al. [25] | Portuguese National Health Service (NHS) provided coverage for ostomy product, without out-of-pocket payment, thus providing better access to this medical device (ostomy products). | Government paying for ostomy products ensured increased access to ostomy products to support patients with intestinal ostomy. | MA is conceptualized in terms of availability (right product) and affordability (right price). |
Rutta et al. [21] | Transition from monotherapies to the use of the combined treatment artemisinin-based combination therapy (ACT) promotes better access, safety, and efficacy of PP. The transition also helped to give access to underserved populations. Also, sales of alternative anti-malarial drugs were impacted. | A better product with proven efficacy and regulation or ban of alternative or less efficacious products increase uptake of the product. Thus, the availability of combined treatment ACTs, especially in low-income countries where malaria is prevalent, improves patient access. | MA is conceptualized in terms of the availability (right product) of PP. |
Schmittdiel et al. [27] | Medicare Part D beneficiaries with diabetes who entered the coverage gap have low levels of communication with physicians about drug costs despite the high perceived importance of such communication. | Patients with chronic conditions taking multiple drugs who are at risk of high costs of drug may benefit from physician–patients communication about the cost of medicines and cheaper alternatives so as to ensure access to PP. | MA is conceptualized in terms of availability (right product) and affordability (right price) of PP, as the cost of products can affect access and medication adherence. |
Simon et al. [28] | Computerised order entry (CPOE) was introduced to reduce medication errors associated with handwritten prescriptions as well as increase safety for patients. CPOE was effective due to the following: governance, preparation, support, perception, and consequences. | COPE represents a meaningful use of health information technology for prescribing, as healthcare professionals enter accurate and complete medication orders electronically and so reduce medication errors and subsequent adverse drug reactions. | MA is conceptualized in terms of the availability (right product) of PP for the right person. |
Vialle-Valentin et al. [32] | Community-based health insurance (CHI) schemes expand access to medicines in low-income countries. | CHI has the potential to improve access to, affordability of, and use of medicines at the household level in low-income countries. | MA is conceptualized in terms of the availability (right product) and affordability of PP (right price). |
Waning et al. [30] | The rural pharmacy initiative (RPI) increases equitable access to products in rural regions by acting as a market driver, stimulating competition in medicine prices in competitor pharmacies, even when they were located in different villages. | An RPI scheme increases access to medicines in rural settings by impacting price competition. | Affordability of medicine. |
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Fatoye, C.; Yeowell, G.; Miller, E.; Odeyemi, I.; Mbada, C. Conceptualisation and Role of Market Access in Pharmaceutical Industry: A Scoping Review. J. Mark. Access Health Policy 2024, 12, 81-99. https://doi.org/10.3390/jmahp12020007
Fatoye C, Yeowell G, Miller E, Odeyemi I, Mbada C. Conceptualisation and Role of Market Access in Pharmaceutical Industry: A Scoping Review. Journal of Market Access & Health Policy. 2024; 12(2):81-99. https://doi.org/10.3390/jmahp12020007
Chicago/Turabian StyleFatoye, Clara, Gillian Yeowell, Eula Miller, Isaac Odeyemi, and Chidozie Mbada. 2024. "Conceptualisation and Role of Market Access in Pharmaceutical Industry: A Scoping Review" Journal of Market Access & Health Policy 12, no. 2: 81-99. https://doi.org/10.3390/jmahp12020007
APA StyleFatoye, C., Yeowell, G., Miller, E., Odeyemi, I., & Mbada, C. (2024). Conceptualisation and Role of Market Access in Pharmaceutical Industry: A Scoping Review. Journal of Market Access & Health Policy, 12(2), 81-99. https://doi.org/10.3390/jmahp12020007