KEY POINTS

• The Access to Medicine Foundation’s 2026 Index found that access plans cover 69% of pharmaceutical companies’ late-stage drug candidates, more than three times the share recorded in 2018.
• Access remains uneven, particularly for cancer and non-communicable disease treatments in low-income countries.
• Only 19% of assessed cancer products had access strategies in low-income countries, compared with 74% in lower-middle-income countries.
• The report identified affordable insulin supply as a major challenge despite growing investment in newer diabetes treatments.
• Novartis ranked first in the assessment, followed by GSK and AstraZeneca.

MAIN STORY

Pharmaceutical companies are making progress in planning how new medicines will reach patients, but significant gaps remain in ensuring that people in low- and middle-income countries can afford and obtain the treatments, according to the Access to Medicine Foundation’s 2026 Index.

The report, released on Tuesday during a webinar marking 20 years of the foundation’s assessment of pharmaceutical companies’ contributions to global health equity, found that access plans now cover 69% of companies’ late-stage drug candidates. This is more than three times the proportion recorded in 2018.

However, the foundation said progress remained uneven, particularly in treatments for non-communicable diseases (NCDs), which include conditions such as cancer and diabetes.

For 43% of NCD-related candidates with access plans, the strategies focused only on registering the products in relevant markets. The foundation warned that regulatory approval alone does not guarantee that patients can obtain medicines, particularly where prices, distribution systems and healthcare infrastructure remain barriers.

The report called on pharmaceutical companies to make access planning a routine part of drug development and work with local partners to identify obstacles before products reach the market.

Cancer treatment was a major area of concern. Oncology products accounted for approximately half of all pharmaceutical clinical candidates assessed, making cancer the largest area of research and development.

Although access plans covered 65% of oncology pipeline candidates, the report found that strategies were in place for 74% of assessed cancer products in lower-middle-income countries. In low-income countries, the coverage was just 19%.

The foundation said the disparity exposed significant geographical inequalities in access to emerging cancer treatments. It recommended stronger partnerships with cancer programmes and treatment centres in developing countries to address challenges involving screening, diagnosis, affordability and healthcare capacity.

The assessment also examined business models designed to reach underserved populations. Six pharmaceutical companies operated multi-country initiatives, compared with five in the 2024 Index. Their initiatives collectively covered all 113 low- and middle-income countries included in the assessment, although limited reporting at product level made it difficult to establish their actual impact.

In diabetes research, the report identified 25 research and development projects across six pharmaceutical companies, with much of the innovation concentrated on glucagon-like peptide-1 (GLP-1) medicines.

Despite the growing focus on newer treatments, the foundation identified access to insulin at affordable prices and through reliable supply channels as a continuing challenge, particularly in lower-income countries.

Chief Executive Officer of the Access to Medicine Foundation, Jayasree Iyer, said two decades of industry assessment had strengthened efforts to address persistent barriers.

“Twenty years of progress have put us in a stronger position than ever to tackle persistent gaps in access.

“The Index has shown what works, companies have more tools at their disposal and access is increasingly being considered earlier,” she said.

Iyer said the next opportunity was to extend effective access strategies to more patients, particularly those in underserved communities.

The foundation’s Director of Research, Claudia Martínez, said the industry had recorded progress through sustainable business models, product approvals, pipeline innovation and new licensing agreements.

“The 2026 Index shows some important shifts in how companies are approaching access. But these efforts are still concentrated among too few companies, products and diseases,” she said.

In the company rankings, Novartis emerged as the leading pharmaceutical company for the second time, followed by GSK. Both companies retained their positions across all three technical areas assessed.

AstraZeneca ranked third, Sanofi fourth and Bayer fifth. Boehringer Ingelheim and Roche shared sixth position, while Pfizer ranked eighth.

The 2026 assessment placed greater emphasis on implementation and measurable outcomes, using fewer indicators to distinguish between companies’ commitments and their actual performance.

The Index covered the period from June 1, 2024, to May 31, 2026, and assessed companies across governance of access, research and development, and product delivery.

THE ISSUES

The findings highlight a distinction between developing a medicine and making it available to the people who need it. A pharmaceutical company may successfully develop a treatment and obtain regulatory approval in a country, but patients may still be unable to use it because of its price, limited distribution or gaps in the healthcare system.

Regulatory approval confirms that a medicine has met the required standards for use. It does not automatically mean hospitals and pharmacies have stocks, health insurance covers the treatment or patients can afford to pay for it.

This is particularly important for cancer treatment. Access depends on more than the availability of a drug. Patients also need screening and diagnostic services to identify the disease, trained healthcare workers to administer treatment, facilities to monitor their response and reliable supplies of the medicines. Where these services are limited, the arrival of a new treatment may have little practical effect on patients.

The difference between the 74% access-strategy coverage recorded in lower-middle-income countries and the 19% in low-income countries also shows that access planning is not reaching all markets equally. A medicine developed for global use may still be out of reach in countries where healthcare systems have less capacity to support its delivery.

The diabetes findings raise a similar concern. GLP-1 medicines are attracting research investment, but the foundation’s warning about insulin access shows that innovation in newer treatments does not remove the need to secure supplies of established medicines. Patients who depend on insulin still need consistent access at prices they can manage.

For Nigeria, these gaps matter because the availability of new treatments depends not only on whether pharmaceutical companies develop or register them, but also on whether they enter the local supply chain at affordable prices and can be supported by healthcare facilities. Stronger partnerships with local distributors, treatment centres and health programmes could help identify these barriers earlier.

The report’s shift towards measuring implementation and outcomes is therefore significant. Counting access plans and company commitments can show whether firms are considering underserved markets, but measuring whether patients actually receive treatment provides a clearer picture of progress.

WHAT’S NEXT

The foundation is urging pharmaceutical companies to expand access strategies across more products and disease areas, while working with local partners to address affordability, supply and healthcare delivery challenges.

Greater attention is also expected to fall on whether companies can demonstrate measurable improvements in access, rather than simply reporting plans and commitments.

BOTTOM LINE

The pharmaceutical industry is developing more medicines and increasingly considering access during research and development. But the 2026 Index shows that innovation alone does not guarantee treatment. The real test is whether patients in poorer countries can afford, obtain and receive the medicines being developed.