Index leaders tend to perform well across the majority of areas the Index tracks, and companies at the bottom of the Index have narrowed the gap with their peers. However, while overall scores are converging, companies differ in the areas where they perform better. The industry is progressing on several fronts, partly in response to calls for action shaping the global health agenda. However, companies struggle to perform well around some aspects of access to medicine, such as ethics breaches and disclosure of patent status.
More companies are experimenting with innovative access-oriented business models. Three have introduced new models and three have expanded pilots. Examples include Merck & Co. offering patients in 11 cities in India zero-interest loans for the purchase of one of its hepatitis medicines; and Novo Nordisk making insulin products more accessible in India, Nigeria, Ghana and Kenya by identifying ways to integrate diagnosis, treatment and control in local communities. However, the impact of such models remains to be seen.
Companies are granting more licences to developing country companies to make and distribute generic versions of their medicines. Of the 16 companies that have patents on their products, eight engage in voluntary licensing. This compares with six companies in 2012. Some licences include groundbreaking new arrangements, such as tiered royalties.
Policies and activities to improve access to medicine continue to get better organized. All 20 companies now have established some form of board-level representation for access-to-medicine issues (up from 19 in 2012 and 17 in 2010). In 2014, seven companies link performance incentives of senior managers to enhancing access to medicine, compared with three in 2012.
All 20 companies commit to follow at least a minimum code of practice for ethical marketing. All have codes of conduct governing bribery and corruption and three-quarters report auditing their codes. However, 18 companies have been the subject of settlements or decisions relating to breaches in ethical marketing, bribery or corruption standards or competition laws. Breaches range from paying or otherwise inappropriately incentivizing doctors to prescribe their products, and encouraging doctors to prescribe their medicines off-label, to collusions delaying market entry of generic medicines and misrepresenting the efficacy and safety of their products or those of their competitors. This evidence raises questions over the commitment and effectiveness of company governance of this area.
Companies remain conservative in their disclosure of where patents are active and when they will expire – information that is very useful to medicine procurers and generic medicine manufacturers. Within the reporting period, no company independently disclosed its patents statuses for any product relevant to the Index.