Biopharmaceutical companies have long worked to expand access to their products, with millions of patients around the world benefiting from life-saving therapies. Such efforts, aligned with the industry’s mission and typically driven through charitable and social programs, aim to narrow the sizeable health disparities that exist globally.

But health equity initiatives have not typically been an integral part of addressing another industry imperative: meeting market and shareholder expectations for steady, healthy growth of the business. Consequently, biopharma’s efforts to expand equity remain relatively limited in scale and impact.

That is beginning to change. Increasingly, companies are building a strong business case for addressing health inequity, both at the country level and between wealthy nations and low- and middle-income countries (LMICs). They are developing strategies to ensure their products are not only widely available and affordable but also adapted to the local context and adopted by patients and practitioners. In doing so, biopharma companies are positioning themselves to reach untapped markets in a commercially sustainable way.

Seizing this opportunity requires a transformation. Biopharma companies must outline a clear commercial strategy for reaching underserved groups—a strategy that may involve different returns than are generated in existing markets—and build teams to execute it. At the same time, they need to integrate health equity criteria into all aspects of their business and decision making. And they must do so at every stage in the product lifecycle, including R&D, as well as in the way incentives are structured within the organization.

The Health Equity Challenge and Opportunity

Health inequity is a broad and significant problem. In the US, for example, Black and Hispanic Americans are 59% and 44% more likely, respectively, to have undiagnosed diabetes compared to white Americans. Black and Hispanic women, meanwhile, receive a breast cancer diagnosis in the early, local stage 10% less frequently than white women.

Disparities also persist between wealthy and less wealthy nations. More than 50% of major health care products controlled by big biopharma companies are not covered by clear strategies for making them available in LMICs. And more than 70% of the internationally recognized R&D priorities for LMICs—for example, tropical and infectious diseases—remain unaddressed.

The barriers that stand in the way of meeting these needs fall into four primary categories:

• Adaptability. Products are not suited to local context, including the characteristics of patients and the health system.
• Availability. Products are not readily available via local manufacturing, regulation, and distribution.
• Affordability. Product costs—a function of factors including pricing, distribution markups, and reimbursement policies—make the therapies unaffordable for some people in the target population.
• Adoptability. A system is not in place to ensure that the patients who could most benefit from biopharma products are aware of, and demand, the therapies available.  

Some leading biopharma companies are working to surmount these barriers. Their actions are based on a robust business case.

First, companies that expand access and adoption of their products will be able to tap into increasingly important markets. Consider that while Europe and the Americas account for more than 70% of biopharma sales today, more than 50% of global population growth between now and 2050 is expected to occur in Africa.

Meanwhile, the need for expanded access to vital therapies will only become more urgent: between 2016 and 2060 the disease burden in low-income countries is expected to grow nearly three times faster than in high income countries.

Second, biopharma companies that deliver on health equity can strengthen the retention, engagement, and motivation of their employees. According to a BCG analysis, biopharma companies can cut their attrition rate by a full percentage point by leading on health equity.

Third, an effective health equity strategy helps companies enhance their relationship with key stakeholders. Payers, for example, are increasingly using their large data sets to identify inequities that need to be addressed. For their part, large providers that also insure patients are looking to partner on equity initiatives. And policymakers are under increasing pressure from constituents to address equity concerns. Biopharma companies can partner with all these players to expand health equity.

Bring Health Equity into the Core

To truly move the needle on health equity, biopharma companies need to view it as they would any commercial objective.

One leading biopharma company recently set out to develop a comprehensive health equity strategy. The company did have extensive institutional experience through numerous managers who had worked on the issue; however, due to the lack of coordination of their efforts—along with constrained resources, competing responsibilities for those who did focus on the issue, and the absence of a clear corporate strategy for health equity—the overall impact was neither sizeable nor measured.

The company’s transformation began with extensive internal conversations and benchmarking to understand the lessons learned from existing initiatives and determine where a newly established health equity team could complement those efforts. Workshops helped the team define its ambition, structure, and ways of working.

The group then conducted detailed quantitative analyses to identify which of its products were best suited to LMIC markets and which patients should be targeted based on factors such as disease burden and access to health services. And the team prioritized the various potential market opportunities to guide the company’s actions over time.

The company now has a well-honed health equity team that is plugged into business teams within the organization that can provide access to proven solutions, partnerships, and other tools. They have prioritized a number of markets and identified the main barriers patients in those countries face and the potential actions to address the obstacles. The goal: to double the growth in the number of patients reached with the company’s products this year.
 

Biopharma efforts to expand health equity have the potential to create sizeable social impact. But such efforts will not be sustainable nor scalable unless they are done in a way that creates business value. Companies that embed health equity into the organization’s strategy can help bridge gaps in health equity both within and across countries. Ultimately, such purpose-driven pragmatism can do even more for society than well-intentioned charity.