ESPE Yearbook of Paediatric Endocrinology

Lancet Glob Health 2019;7: e492–502. DOI: 10.1016/S2214-109X(18)30563-1

• The authors evaluated the effect of a Novartis programme that provides metformin at a wholesale price of US$1 per month in Kenya.

• This cluster-randomized controlled trial significantly increased the availability of metformin at health facilities, but not at patient households.

The pharmaceutical industry is often blamed for excessive prices of medicines that prevent the people most in need to access them. This interesting trial (funded by Novartis, a manufacturer of metformin) reports the outcomes of the Novartis-Access program, an initiative designed to make essential medicines available at an affordable price. A portfolio of 14 medicines, including metformin, that are prescribed for treatment of non communicable diseases (NCDs) such as hypertension, heart failure, dyslipidaemia, type 2 diabetes, asthma and breast cancer, was made available for purchase by a main distributor to public and non-profit health facilities in Kenya, at a wholesale price of US$1 per treatment per month. Patients with known diabetes treated with metformin could in turn buy the drug at this low price. The results of this Novartis-Access program show that the initiative did increase availability of metformin at the health facility level but not at the patient level.

The reasons for these somewhat disappointing results are discussed in depth by the authors. These included lack of awareness of the program, relatively short duration of the trial (although a longer-term evaluation is planned), the fact that patients had to be previously diagnosed, and delayed registration of the medicines by the Kenyan Health Authorities. However, industry-led access-to-medicines programmes are one of several important avenues that can be pursued to improve affordable access to essential medicines and outcome evaluation of these initiatives is therefore a key step. Other sustainable avenues include for instance pooled procurement (whereby a large quantity of medicines is bought at a lower price and distributed between several countries), local manufacturing of drugs and easier approval of medicines in order to increase competition between manufacturers and to decrease drug prices (1).

Reference: 1. Manji I, Pastakia SD. Novartis Access: a small step towards increased access for non-communicable disease care. Lancet Glob Health 2019;7: e398.