Kenya Is the First Country to Receive $1 Medications for Chronic Illnesses
A global pharmaceutical company is taking the lead in the fight against chronic illnesses by offering treatment at extremely low costs.
Novartis recently launched an innovative program called Novartis Access that provides medicine for a variety of noncommunicable diseases, all for $1 per treatment per month. The Switzerland-based company plans to provide 15 patented and generic medicines for cardiovascular diseases, diabetes, respiratory illnesses, and breast cancer. Novartis provides affordable drugs to nongovernmental organizations and other stakeholders in the public sector for distribution.
So why is one of the largest pharmaceutical companies in the world taking on a new business model for a pilot program?
“As a global health care company, we think it’s the right thing to do,” said Nadine Schecker, head of communications for Novartis Access.
Chronic diseases kill 38 million people worldwide every year. Nearly 75 percent of those deaths are in low- and middle-income countries. In Kenya alone, noncommunicable diseases account for 27 percent of all deaths. Breast cancer, for example, is the top cause of death for Kenyan women between the ages of 35 and 55.
The drugs were chosen based on the World Health Organization’s Lists of Essential Medicines. Novartis’ generic division, Sandoz, sets the low price point.
“The way we have approached this is not only to address one disease area at a time but to look into four main chronic disease areas at once and compile a portfolio of medicines where the average price is $1 per treatment for one month,” Schecker said.
Novartis launched the program in Kenya in October, and Ethiopia just agreed to sign on. Vietnam is expected to follow. Novartis recently received its first orders and is aiming for delivery before the end of the year.
At a forum of key Novartis Access stakeholders last week, Marie Aimee Muhimpundu, head of the noncommunicable disease division of Rwanda’s ministry of health, described the situation in her country. Rwanda is considered one of the leading examples in fighting diseases such as malaria, but the high cost of treatments for chronic illnesses is too much to bear for many, she said.
“When someone has cancer, even curable or preventable, it’s a death sentence,” Muhimpundu said at the meeting in Switzerland. “They are giving you a price, and [patients] say, let me go home and die. Everyone in the family will be poor because they have to support the sick patient, and you see most of them abandoning the treatment.”
The company hopes to have programs in 30 countries that include on-site education and outreach for patients to better understand the cause and effect of chronic diseases. To determine which nations it will work with, Novartis whittled down a list of 106 countries and applied a set of criteria including medical need, existing Novartis presence, the size of a team needed to implement the program, and the status of the health care system.
“These are countries where we do believe we could have the highest impact,” Schecker said.
Novartis has been active in infectious disease medicine for more than 40 years, with flagship malaria, leprosy, and cancer programs. In discussions with partners and external stakeholders such as nongovernmental organizations, academics, and local governments, it became clear that there was a serious need to address the rising number of untreated chronic illnesses, Schecker said.
“I would say only recently have these diseases been recognized as an increasing burden and a real threat at a country level,” she said. “The political will to take action is now there, which wasn’t the case several years ago.”
Novartis began exploring options internally about a year ago, and the access program took off this fall. But the planning process was exhaustive, and there was a need to make sure the medicine could continue to be available at this price point in the long term.
The supply chain integrity is key to the program’s substantiality, Schecker said, and also the program’s biggest challenge. Novartis works with the Kenya Medical Supplies Authority and the Mission for Essential Drugs and Supplies to ensure a clean distribution.
“Not only do you need to make sure drugs reach patients and ensure an ongoing and constant supply, but we needed to make sure we didn’t find these drugs in other channels at prices far higher than we’re aiming for,” including black market trade, she said.
“We’re really trying to make it right,” Schecker said. “The rest is coming up now as we are hitting the ground and reality is hitting in.”
But the funding model for Novartis Access isn’t a sustainable one, she explained.
“We expect at some point to break even, but we don’t know exactly when that will be,” Schecker said. “Because we’re addressing chronic diseases, we have to make a commitment over the long term, and it cannot rely on philanthropy donations. But at the same time, we’re considering the population that we’re targeting, and we have to find the price point that is practical and feasible for these patients. For now, the program is not yet sustainable. We hope and expect it to be in five to 10 years.”
The program is still quite new, Schecker said, and everything is a learning process. Novartis has hired Boston University to help evaluate the social impact of the programs.
“We’re trying out something novel. There is nothing comparable to our offering out there at this point,” Schecker said. “We’re very conscious as this is something new, and we’re learning by doing.”
She added, “We’re talking about a program that is still in baby shoes. We have to be quite realistic and open to the external world that we have a vision for this program. We’re committed to being agile and learn and see where the future takes us.”