With the largest proportion of the population relying on government-sponsored healthcare to access drug treatment, payers in emerging markets (EMs) face a constant struggle: how to accommodate more effective, innovative technologies under significant budgetary constraints? Compared to more mature markets, the most recent treatments for a given indication often lack—or experience substantial delays in securing—reimbursement in the EMs. And even when a treatment manages to secure nationwide formulary coverage, regional disparities and healthcare infrastructure often lead to inequality in access to care in the EMs. These and other key considerations play a significant role in the road to market access, and must be carefully accounted for by manufacturers in their launch and P&R strategies in these highly lucrative markets.
Each country is unique—from its access levers and barriers, to the market access landscape for a given disease in each country—all of which ultimately shape brand performance. Two things are certain in the EMs: they require a well-designed, country-specific approach to secure maximum long-term uptake, and brand-specific market access insights are vital.
At DRG, we constantly explore the real impact of payer policy on physician prescribing to get a true sense of how both parties shape specific disease areas in key emerging markets. We’ve put together several exciting new infographics that center on different aspects of this core business need. Here are some sample factoids and the links to download more:
Affordability is a major barrier to uptake of asthma and COPD drugs in China. More than 40% of surveyed pulmonologists in China described patients' high out-of-pocket expense as a major barrier limiting their prescribing, despite the partial reimbursement of most asthma and COPD agents.
All of the anti-VEGF agents for wet-AMD lack nationwide reimbursement in Brazil, Mexico and China. This results in a significant percentage of surveyed ophthalmologists reporting prescribing off-label Avastin for wet AMD, particularly in Brazil and Mexico.
China’s hospital medicine rate has put pressure on physicians prescribing of more costly AChEIs and memantine for Alzheimer’s disease. Hospital budgetary constraints place a prescription limit of about 220 RMB for a Tier 2 hospital in China. Prescribing of existing AD drug therapies, on top of other comorbid diseases, could easily exceed this limit.
More than 50% of ESA-treated Chronic Kidney Disease patients in Brazil, Mexico and China, receive a domestic ESA. “In public institutions, the physician is obliged to prescribe by molecule name, and pharmacies dispense the products purchased by the government. (…) The standard of care is epoetin alpha because it is covered by the MoH. We have received the product from Fiocruz.” CEAF Director in Sao Paulo State, Brazil.
Limitations to biomarker testing in Brazil, Mexico, and Argentina are one of the greatest challenges to access biomarker-driven therapies for oncology. Rates of conclusive test results are ~60% lower in Brazil and Mexico vs. those reported in the US and EU5 (typically 80%+).
For even more on Brazil, Mexico and Argentina:
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