Frequently Asked Questions

The Access to Medicine Index provides standardized information on pharmaceutical companies with regard to their efforts to improve global access to medicines.

For the 2010 ranking data was collected across 111 indicators. The rankings are based on 106 indicators that measure activities across four strategic and seven technical areas. 

The Index serves to encourage companies to act responsibly in this area and play their part in achieving improvements in healthcare at a global level. We strive to provide companies with a transparent means by which pharmaceutical companies assess, monitor and improve their own performance and their public and investment profiles while building a platform on which all stakeholders can share best practices in the area of global access to medicine.

In its most basic form , The Access to Medicine Index is an innovative tool designed to encourage pharmaceutical companies to work towards improving access to medicines by comparing their efforts and by presenting the outcomes to the outside world. 

The Access to Medicine Index was created as a solution to the global health challenge. The foundation itself believes access to medicine is among the most important challenges of our time. With the Access to Medicine Index we hope to facilitate the propagation of advanced policy solutions, improved cooperation between stakeholders, increased public and private awareness, and leading equity and debt investment decision making for the investment community.

The Access to Medicine Foundation is an international not for profit organization dedicated to improving access to medicines to societies in need. Based in Haarlem, The Netherlands, the foundation publishes the Access to Medicine Index, the first index of its kind to rank pharmaceutical companies with respect to their efforts to enhance global access to medicines.

The Access to Medicine Index 2010 is based on data from fiscal years 2008 and 2009 fiscal. The companies covered by the Index had different fiscal years; some December to December and others March to March. 

The Access to Medicine Index is continuously updated following stakeholder feedback and consultation. New companies are added, others disappear, and the methodology covers enhanced sets of criteria, diseases, and countries. What's more, Index scores are relative measures, not absolutes. The Index should be seen as a snapshot, and one should be cautious when comparing Index outcomes with those from previous years. 

• 19 out of 20 originator companies (95%) provided data about their Access to Medicine programs. In 2008, only 9 out of 17 originator companies (53%) chose to do so.
• Most companies, including the top-3, have improved in their transparency, performance and commitments to access to medicine.
• Compared to 2008, more companies shared intellectual property for research purposes; more research collaborations were instigated; several promising innovative approaches were pioneered, and more collaboration with generics companies were established, especially through non-exclusive voluntary licensing arrangements.
• Rapid risers: Gilead Sciences (up from 15 to 4) and Pfizer (up from 17 to 11).
• Lower rankings for Novo Nordisk (down from 2 to 7), Bayer (down from 9 to 14), Bristol-Myers Squibb (down from 11 to 15), Merck KGaA (down from 13 to 17). For Novo Nordisk, there were significant changes in the Index methodology itself.
• The top-10 of originator companies includes six companies based in Europe and four based in the United States. In 2008, seven companies in the top-10 were based in Europe. 

Feedback from the first Index was that the 2008 Index did not include Japanese pharmaceutical companies. This time around we have included this important group and found a positive trend in the policies and practices of the Japanese companies. While these companies lag most of their peers on ATM issues, they have shown promising signs of improvement. All four Japanese companies engaged with the Index 2010 team openly and all are in the process of further developing their Access to Medicine strategies and targets. Among these companies, Eisai is actively engaging in neglected diseases research and making concrete and ambitious commitments for expanding its initiatives in the Index Countries. 

There are 27 companies on Index 2010, comprising 20 drug originators (compared to 17 in Index 2008) and seven generics companies (compared to three in Index 2008). 

Already we have began to see the impact of the Index as companies, that have embraced the Index, have began to use it as a tool for broadening CRS programs into greater business strategies.

In addition, it is our goal that the Index becomes:
• A tool to assist companies develop, implement and measure the direction of their access to medicine programs
• A way for companies to benchmark and share best practices within and across sectors
• For articulating, clarifying, and uniting the dialogue around ‘access’ issue with internal and external stakeholders from institutional investors to nonprofits.
• Positively stimulates investments in access to medicine programs of large pharmaceutical companies.

We strive to promote debate on the access to medicines issue, draw out best practices, facilitate standard setting, and encourage companies and governments to continue to address this important issue.

The foundation researches, publishes and maintains the Access to Medicine Index. It engages pharmaceuticals and asks companies to publicly disclose information on their management and performance in this area. The information is then analyzed, rated and ranked to understand how companies’ current policies and procedures address this issue.

Collaboration and partnerships are essential to the success and sustainability of our work. We collaborate extensively with the World Health Organization, The Bill and Melinda Gates Foundation, government ministries, other nongovernmental organizations, universities and other foundations. We also form unique agreements with institutional investors, ensuring that Access to Medicine Index is available to a variety of stakeholders as needed.

When an indicator is not applicable to a company, neutral scoring is used. For example, when a company has no non-exclusive voluntary licensing, it gets a lower score for commitments and performance for the indicators related to non-exclusive voluntary licensing. However, for the indicator related to transparency of voluntary licensing activities, a neutral score is used. This is because the company has no data to disclose. 

The final scoring of the companies is the result of scoring by the analyst in charge of measuring the company and verified by the analyst in charge of each technical area. Finally the scoring is checked a third time by two senior analysts at RiskMetrics, the research and analysis provider for the Index.

A statistical analysis has been carried out on the final scores to check for significant correlations between different indicators and the distribution of each indicator. Based on this analysis, adjustments were made to some indicators scoring guidelines to ensure maximum variability. In addition some indicators with high correlation were marked for possible removal in the next iterations of the Index. 

The Access to Medicine Index is continuously updated following stakeholder feedback and consultation thus as the industry evolves so will the Index, therefore we do envisage incremental changes in future methodologies. 

To ensure the Index remains valid and impartial, besides input from the companies, other independent sources of information were used to help define company analysis including:

• Patent and registration databases
• Pricing surveys
• Litigation databases

In addition, interviews were conducted with organizations working closely with the companies on ATM related issues. Such organizations included product development partnerships, international procurement agencies, donations management. 

Regardless of company type, the weight of each technical area is split between commitment (30%), transparency (30%), performance (30%) and innovation (10%) indicators. 

The Index 2010 features important methodological refinements that include covering more companies, more diseases, and more indicators. Other important changes are:

• Separate rankings for originator companies (20 vs. 17) and generics companies (6 vs. 3).
• Measurement of actual performance on top of commitments and transparency.
• Additional focus on non-communicable diseasesSpecific coverage of innovations in the sector.
• More diversified sources of information. 

After an extensive feedback process the methodology was enhanced with significant augmentations aimed at increasing the robustness of the Index and brings it in line with current changes to global access to medicine priorities. These enhancements included a separate measurement of performance from commitments and transparency, greater focus on non-communicable diseases, specific coverage of innovations in the sector, more diversified sources of information and a more balanced attention to the scale and scope of the company activities and their size. 

The Index methodology is developed in consultation with an Expert Review Committee (ERC) a committee of experts representing different stakeholders convened engaged in the access to medicine issue. Although the mandate of the ERC is purely advisory in nature, their main objective is to provide guidance, recommendations and advice to the Access to Medicine Index team on the scope, structure, content and methodology of the Access to Medicine Index 2010 assessment. The Access to Medicine Index Foundation remains ultimately responsible for decisions on the final methodology associated reporting material and the findings of the Access to Medicine Index. 

The Access to Medicine Index is based upon extensive research involving numerous interviews, corporate documents and information sources available in the public domain. The Index is the work of an independent research group, RiskMetrics Group. The company has been contracted by the foundation to perform the research and analysis for the AtM Index. It specializes in analyzing corporate performance on environmental, social and strategic governance issues, with a particular focus on their impact on competitiveness, profitability and share price performance.

The Access to Medicine Foundation recognizes the vital role generics manufacturers’ play in providing affordable treatment. Therefore the second Access to Medicine Index will include a separate ranking of generics manufacturers and highlight the important role both business types play in providing access to medicine. The initial ranking will include seven generics manufacturers and we aim to increase this number over time.

The Access to Medicine Index believes that pharmaceutical companies play a critical role in increasing access to essential medicines for societies in need. The Access to Medicine Foundation, has taken this initiative to give industry a voice and a platform to design their access to medicine programs.

Access to Medicine Foundation was founded in 2004.

We are not funded by pharmaceutical companies. Funding to the Access to Medicine Foundation is provided by foundations amongst which the Bill and Melinda Gates Foundation, the Dutch government, Department for International Development (DIFID), and nonprofit organizations.

The first Index was published in 2008; the next Index will be published in June 2010.

Pharmaceutical companies, as with all publically listed companies, are required by law to disclose financial information and have no incentive to provide inaccurate information to the marketplace. In addition, RiskMetrics, the company that is responsible for the research and development of the Index, conducts spot checks on the provided industry data to ensure it is both up-to-date and valid.

The issue of access to medicines is complex, involving factors including development and health policies, health-system infrastructure and best practices, pricing, rational medicine use and adequate funding. While the fundamental aspects of healthcare provision are the responsibility of governments and intergovernmental agencies, the Access to Medicine Foundation plays a supporting role to improve access to medicines.

In the past, investment in Index Countries was not the most attractive option due to risky operating environments. Today, however, rapid economic growth, improving healthcare systems, changing lifestyles, population growth, along with lower R&D and manufacturing costs, signal great potential for meaningful pharmaceutical industry growth opportunities in these regions. According to IMS Health Inc., emerging economies represented only 12% of growth in the pharmaceutical sector in 2001; in 2009, however, they are expected to represent 73% of global growth.

The increased number of acquisitions and collaborations with generics companies has the potential to drive the price of patented products down by providing originator companies with the low-cost production and distribution capacity of generic firms. However, they might also hamper generic competition following the expiry of product patents. 

• More research activities for adapting existing products to the needs of developing countries.
• Emerging examples of capacity advancement in the poor countries.
• For the high-ranking generics companies, increased collaboration with originator companies through non-exclusive voluntary licensing arrangements
• Low level of disclosure on the progress and outcome of access to medicine related initiatives 

Since the launch of the Index 2008, we have seen a number of trends in the sector, including:

• Increased sharing of intellectual property, such as "compound libraries," for research purposes.
• An increase in the number of research collaborations targeting areas of need.
• The development of several promising innovative approaches to access.
• For the high-ranking originator companies, increased collaboration with generics companies, especially through non-exclusive voluntary licensing arrangements.