Eisai Business in Emerging and Developing Countries for Better Access to Medicines
March 28, 2018
The pharmaceutical industry contributes to increasing benefits for patients through continuous endeavors in the development of healthcare innovations, stable supply of quality products, and the provision of medical information for appropriate use. While the development of new drugs is progressing, the importance of innovation in research and development is paramount, as there are still many diseases that have no established treatment or pharmacotherapy.
In some emerging and developing countries, the demand for medicine is on the rapid rise because of expansion of the middle-income class caused by increases in population and economic growth. But, not all patients who are in need of healthcare have sufficient access to it. Factors for this include, but are not limited to, insufficient healthcare infrastructure and insurance coverage, low recognition of disease and treatment, and affordability of care.
Eisai executes its growth strategy for business activities in each region under its organizational structure comprised of the five regions Eisai Japan, the Americas, Asia and Latin America, China and EMEA (Europe, Middle East, Africa, Russia, Oceania). For the Asia and Latin America region where we believe securing access to medicines is especially critical, Eisai has established a core strategy in addition to the patient contribution through innovative new drug development and sales, in order to contribute to improving access to medicines in emerging and developing countries. Our core strategy consists of the following four pillars and endeavors to resolve the issues in an integrated manner.
1. Providing Products at an Affordable Price: Flexible Pricing Suited to Country and Disease
In many emerging and developing countries, healthcare insurance systems are underdeveloped. Even in countries where health insurance systems are developed, there are limits on both the number of people enrolled in public healthcare insurance and the variety of medicines reimbursed by insurance, thus the out-of-pocket payment rates for healthcare are higher. Furthermore, the income on a per capita basis compared to developed countries is relatively low, creating a difficult situation in which many people in these countries cannot obtain the medicines they need (See table below).
|Healthcare insurance||Self-payment for medication||Gross Net Income (GNI) per capita in 2016 (US$)|
|India||Public healthcare insurance only covers civil servants and some private company employees. While private healthcare insurance is available, due to issues such as expensive insurance premiums as well as an inadequate and inefficient healthcare provision system, the enrollment rate is very low. According to World Bank estimates, as of 2010 only 25% of the population has some form of health insurance.||The share of total financial expenditure on healthcare paid by households or out-of-pocket is extremely high at approximately 60%.||1,680|
|Philippines||While insurance coverage has greatly improved through PhilHealth, a national health insurance program initiated in 2013, patient out-of-pocket costs are high.||No payment required for medications on the national formulary at public hospitals, however outpatients are exempt.||3,580|
|Indonesia||A national health insurance system was introduced in 2014, and currently around 170 million, or 66% of the population, is covered.||Currently there is no system of public reimbursement for medicines. Until a new system is introduced, the uninsured have to pay 100% out-of-pocket, and the prescription of generic drugs is increasing due to the implementation of a national health insurance system.||3,400|
(cf. GNI per capita in Japan: US$ 38,000)
Believing that price-setting of medicines also can contribute to the improvement of access to medicines, Eisai strives to realize the broad and sustainable provision of medicines through “Affordable Pricing” in accordance with the social, economic and healthcare environments in each country.
For example, in 2005, we started to supply Aricept (donepezil hydrochloride, product name in India: Aricep) for Alzheimer's disease and the proton pump inhibitor Pariet (rabeprazole sodium, product name in India: Parit) at affordable prices suitable to the social, economic and healthcare environments of India. In addition, in 2017 we launched the novel anti-epileptic agent Fycompa (perampanel) in India at an affordable price for patients. In other Asian countries, we are also engaged in price-setting at “prices that patients are willing to pay to receive the benefit of new epilepsy treatments” derived from market surveys. Similarly, we launched Revovir (clevudine) for chronic hepatitis B in the Philippines at an affordable price in February 2010, in accordance with the affordable pricing policy.
In addition, we are proactively examining affordable pricing for other products in other countries. For the anticancer agents Halaven (eribulin mesylate) and Lenvima (lenvatinib mesylate), we sought to try new pricing scheme. We implemented Tiered Pricing policies which involve establishing multiple price levels for these treatments so that patients’ income levels do not greatly affect their ability to receive the treatment they require. We are expanding this kind of price setting to lower the out-of-pocket burden for patients in eight Asian countries, including India, Indonesia, Myanmar and the Philippines, through schemes that align with the needs of each country. Eisai will continue to pursue sustainable business models tailored to the healthcare systems and economic conditions in each country to enable the delivery of innovative new medicines discovered by Eisai to more patients throughout the world.
Furthermore, toward the elimination of lymphatic filariasis, a neglected tropical disease, Eisai has committed to providing the lymphatic filariasis treatment diethylcarbamazine citrate (DEC) at “price zero” in collaboration with WHO until the disease is eradicated in all endemic countries. The manufacture of these DEC tablets is conducted at Eisai’s Vizag facility in India, which possesses a cutting-edge production line and has obtained GMP (Good Manufacturing Practice) certification from a number of developed countries. As of January 2018, more than 1.2 billion tablets have been distributed to people at risk of infection in 27 countries. Eisai believes that the provision of DEC tablets at price zero increases cost efficiency through optimization of global production and supply systems, and is a form of investment that will lead to more business for Eisai in the future.
2. Providing Disease Solutions including Branded Generic Products
Primarily in disease areas that affect the central nervous system including Alzheimer's disease and epilepsy, Eisai has provided new products developed in-house or licensed from outside parties and accumulated knowledge in these fields. Today, we are enhancing the range of our products trying to create “disease solutions” from the patient perspective, and as part of this we also supply branded generics. For example, in India, we try to offer a wide range of products including our innovative medicines, generics for related diseases and compound products containing more than one active ingredient. This presents more robust treatment options to patients and healthcare professionals.
3. Enhancing Access using Public-Private Partnerships (PPP)
Today there are many patients who do have neither access to basic information about disease nor sufficient opportunities for diagnosis and treatment of that disease in emerging and developing countries. To resolve these barriers to access, we proactively develop PPP with institutions from the public and private sectors as well as not-for-profit organizations (NPOs) and engage in the promotion of the disease awareness activities, the development and provision of diagnostic tools.
4. Leveraging Local Partnerships
To deliver medicines that meet medical needs of patients in a timely manner within the unique business and healthcare environments of each emerging market, Eisai is actively leveraging collaborations with local partners. Eisai strives for improving access to medicines, in partnership with our local partners who have broad knowledge about medical needs, a good appreciation for the business practices and experiences in that country. We not only share our product-related information with our local partners, but also assist local manufacturing capacity building through technology transfers.