In boardrooms across Europe and the United States, I have often heard a version of the same question: “How do we make this viable when most patients are in markets that can’t pay Western prices?” Many global companies still lack a model for launching innovative therapies in low- and middle-income countries (LMICs) that both respects equity and sustains business.
Yet this challenge is no longer peripheral. As scientific breakthroughs increasingly target infectious diseases, maternal health, oncology, and non-communicable conditions prevalent in LMICs, the question of global access has become strategic. The future of pharma innovation will depend not only on discovery but on delivery, and on whether we can make access part of innovation, not a later concession.
The Misalignment Problem
Traditional launch strategies assume a high-income entry point: premium pricing, private coverage, and staged rollouts that follow regulatory alignment. In LMICs, that logic collapses. Out-of-pocket costs dominate, health systems are fragmented, and infrastructure gaps create delays between approval and delivery.
Companies often respond by focusing on “donation programmes” or deep-discount models. These are well-intentioned but unsustainable. They treat access as charity, not strategy. The real question is how to design scalable business models that integrate affordability, local partnerships, and evidence generation.
Redefining Value in Context
In LMICs, value cannot be defined purely in cost per QALY terms. It must reflect societal impact, health system savings, and the broader economic benefit of improved population health. For example, an oncology therapy that enables a parent to return to work or prevents catastrophic household spending creates measurable national value.
To capture that, companies need local data, not imported assumptions. Partnering with ministries of health, academic groups, and NGOs to generate context-specific evidence is not optional; it is essential. Those who invest early in understanding the local burden of disease and care pathways will find payers and governments far more willing to collaborate.
Partnership Over Parachutes
The most effective launches in LMICs are built on partnership, not parachutes. Companies that arrive with ready-made models often fail because they underestimate local realities. Those who co-design access frameworks with governments and clinicians create credibility and sustainability.
For example, tiered pricing can work, but only when accompanied by clear criteria, transparent communication, and capacity-building investments. Licensing arrangements, technology transfers, and local manufacturing can also strengthen long-term supply resilience. These are not acts of charity. They are intelligent investments in market stability and reputation.
Learning from New Models
Recent collaborations in areas such as oncology and rare disease demonstrate what’s possible. Some firms are experimenting with shared-risk models where reimbursement is linked to patient outcomes. Others are building hybrid access structures — private-public partnerships that use data sharing to support affordability while ensuring supply predictability.
The emerging lesson is clear: global access cannot be an afterthought. It must be part of the corporate strategy from day one. The reputational and moral stakes are simply too high.
The Future of Equitable Launches
As the global health landscape shifts, the companies that thrive will be those that understand inclusion as a strategy, not philanthropy. Investors are already paying attention. ESG frameworks and global health impact metrics are influencing valuations and partnership eligibility.
The question is no longer whether companies should engage in LMIC access. It is how well they will do it — with humility, evidence, and collaboration.
The Bottom Line
Innovative drugs that reach only a fraction of those in need have an incomplete impact. The real innovation now lies in delivery models that combine sustainability with equity. That is not just a moral imperative; it is the next frontier of competitive advantage.
Key Takeaways
- Launching in LMICs requires redefining value beyond cost-effectiveness.
- Partnerships with governments and NGOs create sustainable access.
- Local evidence generation strengthens credibility and impact.
- Affordability must be designed, not donated.
- Inclusion and access are emerging drivers of corporate reputation.
Try This
If your organisation is developing a therapy with global relevance, map the patient distribution. Identify which geographies hold the greatest unmet need and assess whether your launch plan reflects that. If not, redesign it.
Closing Thought
Share this with your access and policy colleagues. The future of pharma is not defined by where discoveries happen, but by where they make a difference.
