Pharmaceutical companies are showing what’s possible on access to medicine, but must go further to deliver impact at scale, according to The Access to Medicine Foundation.
The Access to Medicine Foundation is an independent non-profit organisation accelerating progress toward global health equity.
This 10th edition of the Access to Medicine Index is a milestone. Over two decades, we have uniquely tracked how the world’s leading pharmaceutical companies have made essential health products more available, affordable and accessible in low- and middle-income countries (LMICs).
Jayasree K. Iyer, CEO, Access to Medicine Foundation
How do the companies compare in 2026?
The 2026 Access to Medicine Index, which ranks 20 of the world’s largest pharmaceutical companies on their efforts to improve access to essential medicines in low- and middle-income countries (LMICs) finds that while companies are taking steps to improve access in certain areas, progress has yet to reach the scale needed.
- More companies are planning how their products will reach patients before launch, with access plans now covering 69% of late-stage pipeline candidates – more than triple the share in 2018; however, progress remains uneven, especially for some non-communicable diseases (NCDs).
- Cancer products continue to dominate pharmaceutical R&D, accounting for around half of all clinical candidates. Access strategies for these products are beginning to extend beyond high-income markets, while some companies are also addressing broader barriers to cancer treatment.
- Six companies now operate inclusive business models, up from five in 2024, collectively spanning all 113 LMICs in scope. While most companies report growing patient reach, limited granular reporting makes it difficult to assess impact.
- GLP-1s make up the bulk of the diabetes research pipeline. Yet access to these products remains limited in LMICs, while even long-established insulin remains out of reach for many despite the high burden of diabetes in these settings.
- Novartis takes the top spot for the second time, closely followed by GSK, and takes the lead in every area assessed in the Index.
This year’s Index looks back at two decades of change in how companies approach access to medicine – and how the industry has evolved with it. Charting this shift alongside the evolution of the Index itself, the analysis reveals a clear and promising transformation: access has moved from the fringes of company operations, becoming a more integral part of how they do business.
But change isn’t happening fast enough for those who need it. Funding constraints, geopolitical instability and rising health needs are putting growing pressure on the global health ecosystem. Against this backdrop, persistent gaps in lower-resource settings and in care for some critical diseases risk leaving many of the world’s most vulnerable populations behind.
More comprehensive access plans are needed across the product pipeline
Encouragingly, access is increasingly being considered earlier in product development, giving companies more opportunity to anticipate and address the barriers patients may face once a medicine is launched. But the scope of these plans varies considerably. Six promising late-stage medicines illustrate this: while all have access plans, these differ in how comprehensively they address availability, affordability and supply. For NCD products, 43% of plans focus solely on registration rather than addressing wider barriers to access.
Companies now need to build on the progress made in access planning, which has more than tripled since 2018, by making it systematic across pipelines and more responsive to local needs. Working with partners in LMICs can help companies anticipate barriers and develop plans that go beyond regulatory approval to address other factors that determine whether products ultimately reach patients.
Cancer care must be made more accessible, from diagnosis to treatment – especially in underserved geographies
With cancer so prominent in pharmaceutical R&D, it is promising that access plans now cover 65% of oncology pipeline candidates. Access efforts are also extending into lower-resource settings, with strategies identified for 74% of assessed cancer products in lower-middle-income countries and 19% in low-income countries. Companies including AstraZeneca, Bristol Myers Squibb and Roche also stand out for efforts that address wider barriers patients face along the cancer care pathway, beyond access to medicine itself.
The next step is to build on these approaches so that access can better keep pace with innovation. Working with established cancer programmes and treatment centres in LMICs can help companies address gaps across the patient pathway – from screening and diagnosis to affordability and healthcare capacity – and strengthen approaches that can be sustained and scaled to reach more patients.
Better outcome reporting is needed to assess the real impact of inclusive business models
Six companies now operate multi-country inclusive business models designed to reach underserved populations, collectively spanning all 113 LMICs in scope of the Index. Most companies report growing patient reach, while companies are also developing partnerships and taking a longer-term approach to sustaining these models. However, progress varies, and limited product-level reporting makes it difficult to assess who is being reached, with which products and where.
Companies now need to deepen these models in lower-income countries, working with local partners to adapt them to different contexts while embedding financial sustainability. More transparent reporting on patient reach at the product and country level will also be critical to understanding whether these models are truly delivering on access goals.
Diabetes R&D is growing, but insulin access remains a key challenge
The Index finds 25 R&D projects in diabetes across six companies, with innovation heavily concentrated on GLP-1 medicines. Meanwhile, Lilly, Novo Nordisk and Sanofi are taking steps to expand access to insulin, but significant gaps remain, particularly in lower-income countries.
Expanding affordable and reliable access to insulin must be a key priority for global health actors, while ensuring newer diabetes treatments and technologies do not widen existing inequalities. This will require stronger delivery models, partnerships and measurable commitments to expand access.
Novartis takes top spot for the second time, with GSK close behind
Novartis (1st) and GSK (2nd) stand out for their performance, holding these same ranks in all three Technical Areas: Governance of Access, R&D and Product Delivery. These two companies sit clearly ahead of the six high-performing companies that follow, all of which score above average across these areas, including AstraZeneca (3rd), Sanofi (4th), Bayer (5th) Boehringer Ingelheim (6th), Roche (6th) and Pfizer (8th).
Changes to how the 2026 Index assesses companies have sharpened the differentiation of company performance. With fewer indicators and greater emphasis on implementation and measurable outcomes, the 2026 Index places greater weight on where companies are demonstrating meaningful progress in practice.
Source
https://accesstomedicinefoundation.org/news/pharmaceutical-companies-are-showing-whats-possible-on-access-to-medicine-but-must-go-further-to-deliver-impact-at-scale Sara Keller Research Programme Manager, Access To Medicines Foundation
