Improving Access to Medicines: A Framework for Pricing and Patient Access Decisions in LMICs

Improving Access to Medicines: A Framework for Pricing and Patient Access Decisions in LMICs

Improving Access to Medicines: A Framework for Pricing and Patient Access Decisions in LMICs

As LMICs move towards Universal Health Coverage, decisions on health services and medicines coverage of emerging and expanding insurance systems are becoming increasingly important. A key challenge for improving access to medicines is determining which medicines to reimburse, for which patients, and at what price. Building on work we did with government institutions in India and Thailand, this webinar will present a Pricing and Patient Access (PPA) Framework that can help LMIC decision makers address this challenge. The webinar will also discuss experiences from Thailand in developing and implementing its PPA system. Further, webinar participants will be invited to actively contribute to the discussions throughout the webinar.

The PPA framework has three main components:

  1. Achieving the right balance between different competing objectives in health systems including equitable access, maximal access to medicines, and appropriate use of medicines
  2. A structured approach and methodology to set reimbursement prices and access levels for different types of medicines and patient populations
  3. A strategic reform process to continually improve the current coverage and care delivery systems

In the webinar, we will introduce these three components, and discuss in detail the second one. Drawing upon a survey of PPA systems across different developed and developing countries, we propose a structured approach that can help LMIC payers set prices and prioritize access for both generic and patented medicines. Payers can select from an array of tools to inform different decisions they face, such as pricing a unique high value and high cost cancer drug for a small patient population or negotiating prices for medicines for prevalent conditions such as diabetes where multiple competitive treatment options are available.

Finally, we will discuss four lessons from India and Thailand about the PPA system reform process. First, any reform must build on the existing institutional landscape. Second, it must bridge the cognitive disconnect that local stakeholders have between what they know today versus what is possible through a process of awareness building and system strengthening. Third, the process must include collaborative discussions and consensus building among different stakeholders – government, industry, civil society and academia. Finally, the reform process should also include capability building (clinical and management training, information technology, etc.) so that the health system can practically execute the reform.

We invite you to share your views on:

  • The framework presented and challenges you see for implementing it
  • How these challenges could be addressed
  • Your experience with medicines coverage in your country
  • How to assess the impact of health system reforms on access to medicines

Presenters/ Panelists

  • Raja Shankar, QuintilesIMS, UK
  • Maya Malarski, Imperial College, UK


  • Rungpetch C. Sakulbumrungsil, Chulalongkorn University, Thailand
  • Suthira Taychakhoonavudh, Chulalongkorn University, Thailand
  • Surachat Ngorsuraches, South Dakota State University, USA

For any questions related to the webinar or to attend the event in person in London, please contact Raja Shankar (

The webinar is organized by the Health Systems Global Thematic Working Group (TWG) on Medicines in Health Systems. To find out more about and join the group, please visit the Medicines in Health Systems TWG webpage.

Outline of the Webinar

  • 5 mins: Introduction and rationale for PPA systems in LMICs
  • 5 mins: Framework for balancing health system objectives to be addressed by a PPA system
  • 10 mins: Presentation of a PPA framework for LMICs
  • 15 mins: Panel discussion of the Thai experience as an example
  • 25 mins: Q&A

Image credit: Thomas Hawk, Creative Commons license 2.0