A new book by two pharma industry experts offers the first truly global perspective on the complexities of market access.
Even the most innovative drug is useless if patients cannot afford or access it. As pharmaceutical innovation advances, market access strategies – determining who gets a drug, at what cost, and how quickly – have never been more important.
However, the market access process – covering everything from regulatory approval to pricing and reimbursement negotiations, health technology assessment, stakeholder engagement, and distribution and supply chain management – differs wildly between regions.
In the US, for example, private insurance and market-driven pricing dominates (although the Biden administration’s ‘Inflation Reduction Act’ brought in direct government negotiation for certain drugs for the first time, much to the industry’s chagrin). This is a dynamic long-established in Europe, where governments tend to control pricing in the continent’s universal public health systems; although Germany and France do so via workforce-driven insurance-based models, while the UK and Italy rely on tax-funded National Health Services.
Meanwhile, patients in developing economies must often rely on individual out-of-pocket payments to access the medicines they need, although in some, such as China, new blended models that combine government controls with growing private sector influence are being developed.
There are also huge disparities in pharmaceutical spending between rich and poor countries, which impact patients’ abilities to access medicines. Major developed markets spend between USD 500 and 2,000 per person, per year on pharmaceuticals; a figure that drops to between 200 to 500 per year in Latin America and Southeast Asia; and to less than 70 per year in Africa, reflecting limited access, lower purchasing power, and weaker overall healthcare systems.
This inequity has a direct correlation with a country’s health outcomes; for example, 90 percent of cervical cancer deaths occur in low-middle-income countries, while lifesaving HPV vaccination rates stand at above 80 percent in Western Europe and at only 11 percent in Southeast Asia.
The growing complexity and cost of new medicines—some tailored for rare disease patients or custom-engineered based on an individual’s own cells—have made market access more intricate than ever. At the same time, the number of decision-makers involved has expanded, from payers and governments to patients and advocacy groups.
This shifting landscape is what Eric Bouteiller and Annie Chicoye aim to unpack in their new book, published by Anthem Press in December 2024, Fundamentals of Market Access for Pharmaceuticals.
The genesis of Fundamentals stems from a course on market access, led by Bouteiller and contributed to by Chicoye, at China Europe International Business School (CEIBS) in Shanghai. Drawing on the two authors’ vast experience, both in and outside of the pharmaceutical industry, the book also features insights from industry leaders, governments, academics, and patient organisations.
Speaking exclusively to PharmaBoardroom, Bouteiller explains, “We realized there was no one book that integrates a global perspective, so we tried to be very ambitious and write the fundamentals.” “Every country is inspired by others but adapts its own system,” adds Chicoye. “Market access is deeply tied to healthcare history, insurance, and politics.”
A whistlestop tour through the history and current status of market access in key global markets, the book is intended for advanced students in the medical, pharmaceutical or business fields. However, Bouteiller and Chicoye also have high hopes of its usability for pharma industry executives working in marketing, R&D, clinical development and policy roles, as well as consultants working in global launch and pricing strategy.
This comes at a critical juncture in which market access has evolved from a local issue to a global strategic function within pharma. Companies are having to integrate market access ever-earlier in the R&D process and increase communication between the R&D and public affairs teams to avoid launch failures. As Chicoye put it, “If you don’t think about access early in development, you might get to market and find that nobody wants your drug.”
In addition to earlier consideration of market access in the R&D process, pharma is also having to now justify its value to multiple stakeholders, not just governments. For example, patient involvement in pricing and value discussions is increasingly significant, especially in developed markets with well-functioning patient advocacy groups.
Thinking about access also means thinking beyond the four walls of companies’ R&D labs and indeed beyond national borders. “Companies are global, but healthcare systems are local,” affirms Bouteiller. “Market access remains highly fragmented, making a global perspective crucial.”
The book focuses on historical and structural fundamentals, rather than speculative forecasts and aims to provide a balanced viewpoint. Access to medicine is after all, in many cases the difference between health and sickness, life or death; making it an emotionally charged debate, with competing interests keen to fight their corner. “Governments complain about budgets, companies about prices, patients about delays,” says Bouteiller. “We try to bring balance.”
Market access is no longer just an industry concern; it is a critical healthcare challenge, a public policy issue, and an economic debate. Fundamentals of Market Access for Pharmaceuticals aims to provide a toolkit for decision makers looking to better understand these dynamics, ultimately ensuring that more medicines reach those who need them most.
