Access to Healthcare
Access to healthcare in low- and
middle-income countries

At Bristol Myers Squibb, we believe in the value our medicines bring to patients and society and our role in transforming care to help patients live longer, healthier and more productive lives. We promote health equity globally and strive to increase access to life-saving medicines for populations disproportionately affected by serious diseases and conditions, giving hope and help to some of the world’s most vulnerable people.

Access to safe, effective and quality medicines is a complex, multifaceted issue that includes addressing systemic barriers to access and ensuring medicines are available, accessible and appropriately used. BMS supports efforts to ensure broad and equitable access to medicines and healthcare services and has numerous programs around the world to help strengthen health systems capacity and access to treatment for serious diseases.

Despite many efforts by a broad range of stakeholders to improve access, many systemic barriers still exist. BMS believes that shared responsibility and collaboration among all relevant stakeholders is essential to maintain and improve access to quality healthcare.

In low- and middle-income countries (LMICs), in addition to the presence of diseases such as HIV and hepatitis C (HCV), the rates of noncommunicable diseases (NCDs) are increasing — including cancers, cardiovascular disease, diabetes and asthma. NCDs account for more annual global deaths than communicable diseases, and LMICs experience the greatest share of NCDs (77%) and premature deaths (85%) .

Providing access to medicines to treat these conditions is highly complex. Obstacles include lack of funding, infrastructure and distribution channels; lack of electricity and clean water; scarcity of local healthcare professionals and training; poor public awareness; and taxes and trade barriers.

BMS has long pioneered landmark initiatives for access to HIV and HCV medicines in LMICs. Building on this legacy, BMS has also taken important steps to address cancer as a significant NCD. Across initiatives, BMS has collaborated with relevant stakeholders who share in the commitment to strengthen health systems and enable greater access.

BMS’ approach to access in LMICs aligns with our overall commitment to transform treatment and defeat serious conditions worldwide. Our pricing governance in LMICs is identical to that in our footprint markets, but with an emphasis on affordability and partnerships with local healthcare systems to ensure effective and appropriate delivery of medicines.

We bring our human touch to the communities where we work. And we conduct our global business with the utmost care and compassion. We also drive and support several programs designed to build capacity, and raise patient awareness of topics including prevention, diagnosis and access to treatment and care.

BMS’ approach to access in LMICs

Healthcare Capacity Building

BMS is continually engaging in various capacity-building initiatives. For example, we are a leading member of Access Accelerated, a partnership of 24 biopharmaceutical companies working to identify effective solutions for patient care in LMICs. Access Accelerated is uniting the expertise of its member companies to accelerate solutions with a focus on supply chain, primary care and digital health. BMS also participates in collaborations including City Cancer Challenge (C/CAN), NCD Alliance and more, which are working to strengthen health systems through various mechanisms such as physician training, patient education, building capacity for care at hospitals and clinics, funding and more.

Demonstration and Scaling Projects

BMS has conducted pilot programs to supply medicines and/or test various hypotheses such as health system capacity, feasibility, and safe and effective use of medicines (programs may involve medicine donation, or funding technical expertise). Current efforts are building upon actions ongoing for several years, such as:

Affordable Access

BMS is addressing affordability and providing medicines via various solutions, such as product donations, tiered pricing and voluntary licensing.

• Since the early 1990s, BMS has operated a multifaceted program (HIV Global ACCESS Program) to improve access to medicines. This includes antiretroviral pricing that reflects no profit in sub-Saharan Africa and low-income countries, an HIV medicines patent policy reflecting a commitment to access through generic manufacturer participation in many countries, and partnerships with others committed to fighting HIV/AIDS.
• BMS has been involved in innovative programs such as product donations as well as voluntary licensing agreements with Medicines Patent Pool to allow generic manufacturing of atazanavir (HIV) in 122 countries and daclatasvir (HCV) in 140 countries. We continue to optimize the footprint accessible to sublicenses.
• BMS supports innovative pricing approaches that increase patient access to medicines. A BMS cross-functional team is developing an affordability pricing and distribution framework for the BMS portfolio, starting with an affordability pricing pilot in select LMICs. Learnings from the pilot will enable BMS to develop an optimal approach for providing access to innovative drugs in LMICs.

Without scientific and coordinated interventions, the gap will continue to broaden, while innovative medicines remain restricted to patients in high-income countries. The Global Health Equity Platform (GHEP) was established to leverage strategic partnerships with key academic institutions, global health societies and nongovernmental organizations to develop and implement strategies and solutions that optimize healthcare systems in LMICs. Through the GHEP, we are collaborating with institutions and societies on prioritized initiatives:

1. Telehealth and Educational Support initiatives which support programs that introduce or optimize telecom technology to promote long-distance professional health/disease education in LMICs.
2. Capability Building initiatives which enable sustainable and efficacious administration of innovative cancer therapies in low- and middle-income settings.
3. Global Health Knowledge Expansion initiatives which provide societies/organizations with funding to support fellow/student research projects focused on infrastructural improvement and digital health optimization.

Since 2018, 25 grants have been awarded to world-leading cancer centers and societies through the Celgene Cancer Care Links program, which addresses cancer care capacity building in more than 10 resource-constrained countries. GHEP, formerly Oncology External Affairs, has been managing Cancer Care Links grants since Q4 2019.

Innovative Medicine Access Initiative

BMS is participating in the “Innovative Cancer Medicine” partnership along with another pharmaceutical company, the Parker Institute for Cancer Immunotherapy, and the Clinton Health Access Initiative. Through the initiative, demonstration projects are being planned in sub-Saharan Africa.

Access Accelerated

BMS is also a member of Access Accelerated, a partnership of 24 biopharmaceutical companies developing innovative and sustainable solutions to improve access to treatment and care for noncommunicable diseases in LMICs, including cancer. BMS and the Bristol Myers Squibb Foundation are leading the way in improving access, with 19 programs in 15 countries. The vision for Access Accelerated is a future where no one dies prematurely from treatable, preventable diseases, and where all people living with or at risk of NCDs have access to appropriate, quality and affordable prevention, treatment and care. As part of that initiative, BMS and member companies are working to identify the most effective interventions in prevention, treatment and care in LMICs and provide funding and technical expertise to accelerate solutions to supply chain, primary care and digital health barriers experienced in LMICs.

Treating patients with β-thalassemia in LMICs

Our aim is to provide medicines to patients who need them. We rely on several companywide policies, programs and innovative initiatives to guide our efforts. One such initiative is for Reblozyl (luspatercept) to address unmet medical needs for patients who need treatment for beta thalassemia (β-thal).

Approximately 90% of β-thal patients live in LMICs, where there are shortages of safe transfusions, creating a globally significant unmet need for treatment of β-thal. The first phase of this initiative includes an assessment of the disease epidemiology and patient needs in LMICs, an assessment of existing healthcare system capability for managing patients with β-thal in these countries and an evaluation of capacity-building programs, including supply chain requirements that will be needed in order to make treatment available, safe and effective.

Building capacity for cancer treatment

Bristol Myers Squibb and the Bristol Myers Squibb Foundation have been leading in capacity-building initiatives for decades and believe that capacity building and health system readiness are essential for the provision of all medicines, and especially for medicines to treat cancer. Without local stakeholder commitments to fighting a disease and the infrastructure and resources needed to diagnose, treat and safeguard consistent availability of medicines for patients, the delivery of medicines, by itself, will have only limited ability to enhance access.

• With philanthropic funding from BMS and the Bristol Myers Squibb Foundation, the SECURE THE FUTURE® program in 1999 committed approximately $245 million through 2016 to address HIV/AIDS and cancer. This program operated in nine African countries and funded more than 250 projects supporting the creation of innovative models of patient care.
• In developed countries, 80% of pediatric cancers and blood disorders are cured, while in LMICs, only an estimated 15-45% are cured (WHO Fact Sheet—Childhood Cancer). This is largely due to a significant lack of healthcare workforce and treatment capacity. In an effort to address this disparity and improve outcomes for thousands of children in Africa, in 2017 the Bristol Myers Squibb Foundation, in partnership with Texas Children’s Hospital and the governments of Malawi, Botswana and Uganda, launched Global HOPE (Hematology-Oncology Pediatric Excellence). Global HOPE is a comprehensive initiative focused on building long-term capacity to treat and dramatically improve the prognosis of thousands of children with cancer and blood disorders in southern and eastern Africa. To date, more than 12,000 patients have been treated, and 4,000 healthcare professionals have been trained.
• In sub-Saharan Africa, lung cancer has been dramatically misdiagnosed due to the symptoms being very similar to tuberculosis (TB). The Bristol Myers Squibb Foundation developed the Multi-National Lung Cancer Control Program in partnership with six collaborating countries (Tanzania, Kenya, South Africa, eSwatini, Ethiopia and Lesotho) and the WHO Stop TB Partnership to establish admission protocols for patients presenting with symptoms so lung cancer patients can be effectively diagnosed earlier and provided with the appropriate treatment.