Integrated access programs & markets

Novartis has been pioneering social business models for more than 10 years. Our experience in implementing social business activities and community health education has provided important lessons for expanding access to affordable medicines and delivering quality care in lower-income settings.

Novartis access framework

Our access framework can be adapted to the needs of people across income segments

In particular, our experience with Novartis Access, our portfolio of medicines addressing key noncommunicable diseases (NCDs) and childhood pneumonia, revealed that we had to expand our offering to additional therapeutic areas in order to best meet healthcare needs. Further, although our pricing was attractive (USD 1 per treatment per month for the portfolio), our model should be more flexible. (See Evaluating Novartis Access).

“How do we make broader access possible? In addition to having more affordable prices, it is also about working with health systems and partnering with governments, payers and relevant organizations to accelerate access to transformative therapies”

We are also investigating ways to expand on our direct market approach in the three countries where we assume responsibility for the full Novartis portfolio (Laos, Cambodia and Nepal) to build a roadmap that will enable us to deliver better solutions for underserved patient populations. In these and other countries in Latin America, we are exploring how to best address unmet needs in complex environments through a cross-divisional approach and with the right partners.

Once more, our experience on the ground showed that delivering quality care along the patient journey – from diagnosis to treatment and disease management – requires strong healthcare systems. To support this, we will place even more emphasis on health system strengthening activities in the future.

In 2020, we created the Integrated Access Programs & Markets (IAPM) unit to help apply these learnings more consistently and support our shift to further integrate social business activities into our core business and operations. The new unit builds on the core capabilities of our former Novartis Social Business group and aims to better leverage synergies across our Global Health & Corporate Responsibility organization, our Innovative Medicines and Sandoz Divisions, functions and regions. IAPM includes Novartis Access, Healthy Family, direct markets (countries where IAPM has full responsibility for the entire Novartis product portfolio), and a new center of excellence to facilitate the implementation of the Novartis access principles across the company, with a focus on health system strengthening.
While the structure has changed, our commitments remain the same. We continue to develop global health programs and social business models, with the ambition of advancing them into sustainable solutions that can be scaled in the market.

Novartis Access

Novartis Access provides on- and off-patent medicines addressing childhood pneumonia and key NCDs (cardiovascular diseases, type 2 diabetes, respiratory illnesses and breast cancer). Medicines are offered together with capacity-building activities to strengthen health systems in lower-income countries. Novartis Access currently operates in 14 countries across Africa, Asia and Latin America, and has reached 4.5 million patients since launch.

Our social business initiatives around the world

In 2020, as part of the transition of our social business activities into IAPM, we undertook an in-depth assessment of unmet medical needs in LMICs based on data from the Institute for Health Metrics and Evaluation, the WHO and medical reviews. When an unmet need was identified, we analyzed the feasibility of producing and registering medicines to effectively address this need in target countries. Based on this analysis, we are considering additional therapeutic areas for our future Novartis Access offering.

With nearly 30% of the population living below the poverty line, Latin America is home to some of the poorest populations in the world. People living in disadvantaged communities are disproportionally affected by NCDs and are particularly vulnerable to the health and socio-economic impacts of the COVID-19 pandemic. This situation adds to the unprecedented migration crisis facing the region. Despite operational challenges due to COVID-19, we achieved an estimated patient reach of 69 000 patients in Venezuela, El Salvador and Colombia in 2020. We aim to expand Novartis Access to more Latin American countries over the next years.

In Asia, we are continuing to operate Novartis Access in Pakistan and Vietnam. In Pakistan, we launched a new digital medicine dispensing service in partnership with the Health Promotion Foundation in Karachi. Data gathered through the platform enables the foundation to see if Novartis Access medicines are dispensed in accordance with guidelines, identify disease hotspots, gain insights into comorbidities, and monitor adherence. By having access to aggregated data, Novartis is able to track usage patterns and prevent product stockouts. Approximately 800 patients were registered in 2020, and we have signed an agreement with a second NGO to launch a similar solution in 2021.

Evaluating Novartis Access

We have invested in rigorous evaluation to measure the impact of Novartis Access. In 2019, we reported on interim results of an independent evaluation of Novartis Access in Kenya, conducted by Boston University in the US.

Final results were released in 2020. They demonstrated that Novartis Access did not have a major impact on NCD medicine access at the household level for various reasons, including the lengthy process in registering the portfolio, which made it difficult to get medicines into supply streams. Further, involving end users at the county and household levels (instead of stakeholders at the central level alone) prior to launching Novartis Access in Kenya would have informed refinements that may have increased impact. It was also widely acknowledged that the conclusion of the study came too soon, and ideally the evaluation should have continued for an additional one or two years.

Yet, overall, academic researchers commended Novartis for investing in a gold standard, transparent evaluation, which is the first randomized, controlled trial of its kind. Further, learnings will benefit companies in designing access interventions that are more likely to be successful, undertaking rigorous measurement and evaluation from the outset. Several papers linked to the study were published, for instance on equity in access to NCD medicines in Kenya.

We had started evolving Novartis Access based on interim findings. We will further strengthen our efforts around NCD screening and local procurement processes, especially where molecule-based tendering is the norm, and work with local authorities to help ensure patients can benefit to the greatest extent possible from Novartis Access medicines. The final results will further guide our journey toward strengthening the program and our overall approach to expanding access to medicines. Moving forward, we aim to further empower Novartis country teams in the implementation of our access objectives, and focus more strongly on health system strengthening.

Novartis Healthy Family

The Novartis Healthy Family programs are innovative social business models that build local, sustainable healthcare capabilities for populations at the base of the income pyramid. They address social issues that impact access to healthcare, such as education, infrastructure and distribution. The programs are operational in India (Arogya Parivar), Kenya (Familia Nawiri), Uganda (Familia Nawiri) and Vietnam (Kung Kong Khoe). Each program is unique and adapted to the country’s healthcare priorities and local customs. To be included in the respective portfolios, products must be simple to use and tailored to meet the needs of underserved rural populations with a low disposable income.

Since 2007, the combined outreach for all projects across the four countries has delivered health education to more than 66 million people. Beyond delivering education and healthcare, the programs also provide people with jobs, income, and skills enhancement – opportunities that may not otherwise exist in rural communities.

In 2020, despite challenges posed by the COVID-19 pandemic, we continued to make progress in all four countries, adjusting to the situation as needed.

For example, in India, we were able to maintain activities in 285 out of 300 project cells thanks to a change in approach. Instead of hosting health education meetings with community groups, we switched to a door-to-door model and partnered with schools to deliver health education to classrooms virtually. We also partnered with state governments in educating communities about COVID-19. Additionally, in Bihar state, we engaged communities in 2 400 villages, educating families about the national health insurance scheme known as Ayushman Bharat. As a result of providing this education, the number of individuals enrolled in health insurance nearly doubled.

In the first quarter of 2020, in Kenya and Uganda, we organized 204 health camps offering NCD screening, which were attended by more than 30 000 people. In total, we reached nearly 130 000 community members with health education in both countries. Due to restrictions on mass gatherings, in April we halted all community-based education and outreach activities. Similarly, in Vietnam, restrictions led to a 50% reduction in program coverage compared to 2019.

Overall, in 2020, Healthy Family programs brought direct health benefits to over 180 000 patients through diagnosis and treatment. Moving forward, we are working to expand our Healthy Family programs to reach more underserved communities in Asia and other regions.

Direct markets

In Asia, our plans to expand direct market activities into Laos, Nepal and Cambodia were impacted by COVID-19. In Cambodia, we are also adapting our strategy following an EU ruling classifying the country as one of 12 high-risk countries for money laundering. Moving forward, we plan to support the healthcare system through scientific knowledge exchange rather than the marketing of Novartis products. For example, working with medical scientific liaisons, we are disseminating guidance to physicians on the effective prevention and treatment of ophthalmologic and cardiovascular diseases. In Laos, we continued to distribute products from our ophthalmology portfolio. We were unable to expand into Nepal due to COVID-19 restrictions.

In addition, in Latin America, we conducted an assessment of public health needs in our first two direct markets: Paraguay and Bolivia. Breast cancer and cardio-metabolic diseases stood out as areas where there is significant need in both countries. Further, in Bolivia, where Chagas disease has the highest prevalence in Latin America, we are exploring a cross-divisional approach to treat Chagas-related cardiomyopathy and associated cardiovascular diseases.