Despite remarkable achievements in science and medicine, millions of people still lack access to healthcare services.20 As the world’s largest healthcare company, Johnson & Johnson is committed to improving access to our innovative medicines, vaccines, devices and diagnostics in all countries.
Many factors impede access to basic health services and risk optimum health outcomes for underserved populations. In addition to the affordability of medicines, weak health infrastructure, lack of skilled health workforce, inadequate financing options to cover medical needs, and insufficient regulatory capacity to run effective healthcare delivery systems all have varying impacts in different countries.
Our approach to improving access to healthcare is embodied in our business strategy and led with a dual focus: Janssen’s Global Commercial Strategy Organization leads access strategies across the developed world, and our Global Public Health team leads access strategies in resource-limited settings. Our approach includes:
- Improving affordability through various mechanisms, such as equity-based tiered pricing, value-based reimbursement schemes, licensing agreements and product donation programs;
- Continuous innovation for better health, aimed at reducing the burden of the world’s most intractable diseases;
- Strengthening public healthcare systems around the world through health workforce capacity building, medical education, and improving supply chain operations; and
- Contributing to community health through a range of initiatives that provide support for patients in different countries.
Johnson & Johnson is an original signatory of the BSR Guiding Principles on Access to Healthcare that underscore the importance of reducing the global burden of disease through collaboration, R&D, expanding availability of healthcare services, developing health systems resources, and respecting human rights.
For nearly a decade, Johnson & Johnson has ranked among the top three companies working to expand global access to medicines, according to the Access to Medicine Index (ATMI). The 2018 Index highlights Johnson & Johnson’s unique global public health business unit, commitment to R&D for diseases of the developing world, and leadership in health system strengthening. Johnson & Johnson was also highlighted as one of the two pharmaceutical companies leading the AMR efforts with the highest number of activities; specifically, the contribution of our work on TB was called out as a best practice.
Johnson & Johnson has been consistently a leader in the last four Access to Medicine Indices, bringing forward valuable treatments in areas such as TB and recently addressing mental health in low- and middle-income countries. Its Global Public Health Unit is a model among the industry on access planning and results for several therapeutic areas, constantly challenging itself to do more. As a company with a strong R&D pipeline and a global network capable of further addressing the needs of those in the most challenging countries, we encourage Johnson & Johnson to take even more action.
Improving Access and Affordability
To enhance and sustain broader access to our medicines and devices, we pursue a wide variety of approaches appropriate to the specific reimbursement systems and legal guidelines of different countries. Using tools such as equity-based tiered pricing and partnerships with public health organizations, we strive to engage stakeholders to help achieve broad and timely access to our medicines in a way that is affordable locally. We believe that equitable tiered pricing—which considers and reflects the economic conditions of the country, the purchasing power of the patients, the disease burden, and the specific product under consideration—can provide a fair and sustainable approach to improving access across different markets, particularly in emerging healthcare systems.
Improving access and affordability takes several forms, in addition to pricing decisions. We maintain an advanced approach to sharing intellectual property to lower the price of development and access to medicines in relevant markets. We also promote rapid product registration to ensure medicines can be available as soon as possible in different markets. In addition, we engage in partnerships, training and capacity building, and several other initiatives to help make our medicines promptly available for those who need them.
Key access initiatives
Three ongoing access initiatives reflected in our Health for Humanity 2020 Goals include:
- Expanding access to HIV/AIDS treatment, developing the first HIV vaccine, and improving HIV diagnostics;
- Ensuring affordable and sustainable access to MDR-TB treatments;
- Promoting treatments to address neglected tropical diseases.
Enhancing access for ZYTIGA
Under Johnson & Johnson's Value, Access and Pricing policy, we have a commitment to ensuring timely access to our medicines in a way that is affordable locally. Understanding that for resource-limited settings, public finances for healthcare spending are often significantly constrained, Janssen works with public payers, where appropriate, to optimize coverage of our products in relevant disease states, including oncology. For example: Janssen has sought to enable access for patients to ZYTIGA (abiraterone acetate) for metastatic prostate cancer in low affordability countries through a variety of pricing and access program offerings and mechanisms, including equity-based tiered pricing and patient access programs.
Supporting access in the United States
In the United States, we provide resources to patients, caregivers and healthcare providers through the Janssen CarePath program, which helps patients gain and maintain access to the Janssen medicines they are prescribed. In 2018, we helped approximately one million patients with access, affordability and treatment through the Janssen CarePath program, including approximately 550,000 commercially insured patients who reduced their out-of-pocket costs through the Janssen CarePath Savings Program. For more information, see the 2018 Janssen U.S. Transparency Report.
Partnership for access
We are members of the Access Accelerated partnership, a first-of-its-kind global initiative addressing the rising threat of several diseases in low- and middle-income countries. The partnership gathers a broad group of stakeholders, including the World Bank, the Union for International Cancer Control, and pharmaceutical companies with a shared vision of working toward the UN Sustainable Development Goal target to reduce premature deaths from non-communicable diseases by one third by 2030. The initiative will focus on access to primary healthcare, as well as financing, regulatory and service barriers.
Access-driven pricing strategies
We carefully consider three components when pricing our medicines:
- Value to patients, the healthcare system and society. We consider how each medicine will improve patient health as well as the medicine’s potential to reduce other costs, such as surgeries, hospital stays or long-term care, and the improvement the medicine represents over the existing standard of care.
- The importance of maintaining affordable access to medicines for people who need them. We consider not just the list price, but also the discounts and rebates we provide insurers, pharmacy benefit managers, governments, hospitals, physicians, and other providers of care to support broad access to our medicines.
- The importance of preserving our ability to develop future groundbreaking cures and treatments. We have an obligation to ensure that the sale of our medicines provides us with the resources necessary to invest in future R&D to address serious, unmet medical needs.
Transparency on pricing
Janssen Pharmaceutical Companies of Johnson & Johnson releases an annual U.S. Transparency Report reflecting our commitment to putting patients first, including how we invest our resources, price our medicines, and help people who need Janssen medicines get access to them. Read more in our section on Upholding Transparency.
We believe that flexible intellectual property management is a key element in an effective and sustainable access to medicines strategy, especially in low-income and low-to-middle-income countries. Intellectual property systems encourage innovation and allow us to invest in new technologies, fund R&D, and bring transformational medicines to the market. We work with international funders, local governments and non-governmental organizations to develop approaches that benefit patients in need, while continuing to uphold the value of intellectual property in all parts of the world.
Johnson & Johnson is a member of the Patent Information Initiative for Medicines (Pat-INFORMED), a joint initiative that aims to “promote the accessibility of patent information for health agencies tasked with procurement of medicines.” The Pat-INFORMED database seeks to link public patent information to registered medicines in a global online portal that helps health professionals navigate the medicine-procurement process for the benefit of patients.
Sharing molecular libraries to fight neglected diseases and pandemic threats
As part of the Johnson & Johnson global public health commitment, Janssen Pharmaceutica NV (Janssen) has established collaboration agreements with the goal of accelerating the discovery of new treatments for tuberculosis, malaria, neglected tropical diseases (NTDs) and other diseases prevalent in the developing world. Through WIPO Re:Search, the international research consortium led by the nonprofit BIO Ventures for Global Health and the United Nations World Intellectual Property Organization (WIPO), Janssen has opened segments of its molecule library—containing a set of 80,000 diverse, high-quality chemical compounds—to the global research community to enable collaborators to identify and advance promising drug candidates that might have activity against NTDs, and others such as malaria and TB. For more information, see Combating Neglected Tropical Diseases.
Accelerating Product Registration
We are committed to the timely registration of our products to ensure early access and availability of our medicines as well as helping strengthen the regulatory science capabilities of local authorities to expedite product registrations, shaping the environment to accelerate registrations in countries with limited regulatory resources. We work with the WHO to prequalify certain medicines as an important step toward advancing global access. To further accelerate submissions, we maintain a program that assesses emerging markets’ regulatory and commercialization needs during key R&D milestones, and integrates these needs into our global strategies, tracking the speed of getting these products to patients by using an integrated dashboard.
The focus of our registration efforts in these countries continues to be prioritized by:
- high-burden disease prevalence;
- immediate patients in need;
- healthcare infrastructure;
- maturity of treatment programs;
- the existence of global/multilateral programs; and
- economic vulnerability.
During the development of a compound, the need for specific access provisions for resource-limited countries is assessed from an unmet public health perspective and affordability, which is grounded in Janssen’s Value, Access and Pricing (VAP) framework. This process aims to understand the unmet medical need in a market, how the compound addresses the unmet need, relevant price comparisons, the cost burden of the disease, and the affordability of the medicine consistent with Gross National Income per capita. VAP is applied systematically for all Janssen R&D products.
Innovating with Patient Engagement
Patients have always been at the center of everything we do. With the role of the patient changing—from a recipient of care to a collaborative partner—we are on a mission to embed the patient voice throughout our product development cycles in our Pharmaceutical and Medical Devices businesses, beginning with disease area strategies through clinical trial designs, product formulation and product marketing. Our latest innovations are focused on empowering patients and addressing gaps in how healthcare is delivered. In some cases, we invite patients to co-create with us by helping to modify product design.
Using technology to improve patient engagement
The Integrated Smart Trial & Engagement Platform (iSTEP) is a first-of-its-kind tool that replaces paper-based processes with digital tools to manage medicine supply, drug accountability, patient medication intake and health data. iSTEP also enables personalized patient engagement during the clinical trial. Through a smartphone app, iSTEP provides reminders, dosing instructions and tutorial videos with a goal to educate patients and help them to adhere to the treatment regimen. Plans are to utilize iSTEP across multiple Phase 2 and 3 trials in the 2019/2020 timeframe.
We also use eConsent, which uses modern technology and multimedia components to create an interactive and engaging informed consent experience for potential trial participants. Janssen pioneered the implementation of eConsent in multi-country/multi-language trials, has helped to enable broad cross-industry adoption, and is a key contributor to the TransCelerate BioPharma eConsent initiative. The Medicines and Healthcare products Regulatory Agency recently issued a statement on the use of eConsent in the UK, and Belgium has approved electronic signatures.
We also use technology to help those managing mental illness, such as family members and other caregivers who play a critical role in the treatment process. Janssen is conducting a unique study to determine whether caregivers might fare better if provided with individualized training and interactive support. We participate in industry initiatives and, as part of a European collaboration, we demonstrated a groundbreaking virtual reality technology, called SchizoLab, to help people better understand what it is like to live with schizophrenia.
Improving the prevention of mother-to-child HIV transmission
Since 2016, Janssen has been partnering with Solidarity and Action Against The HIV Infection in India, a non-governmental organization working to strengthen HIV prevention, care, support and treatment interventions in India. The collaborative program utilizes locally relevant approaches to educate pregnant women with know-how to prevent mother-to-child HIV transmission. Leveraging the unique CONNECT FOR LIFE approach, HIV-positive pregnant women are enrolled in the program and followed for 18 months post-delivery across two states in India, addressing the disease burden in private and public healthcare facilities. In 2018, the program has been scaled to an additional four high-burden states, addressing the needs of both rural and urban HIV-positive women, and has also demonstrated statistically relevant results—improving retention in care for women supported through the program over 18 months post-delivery.
Promoting online health advocates
In 2018, the Janssen U.S. fourth annual HEALTHEVOICES conference brought together 120 advocates representing more than 35 different health communities for skill-building, networking and empowerment. HEALTHEVOICES continues to be the only event dedicated exclusively to strengthening an increasingly prominent group of influencers: online health advocates. HEALTHEVOICES provides resources and inspiration to empower these advocates to strengthen their patient and caregiver communities.
Improving patient adherence
To encourage the development of new approaches to improving patient adherence to treatment regimens, in 2018, we created a QUICKFIRE CHALLENGE on this topic through our JLABS innovation ecosystem. According to the Network for Excellence in Health Innovation (NEHI), poor medication adherence is estimated to cost more than $290 billion in avoidable U.S. medical spending annually. Empowering patients, caregivers, and providers through connected health technology innovation is recommended by NEHI to foster patient-specific adherence solutions. The winner of the Challenge, HealthBeacon Ltd., was awarded $75,000 to help scale its smart system that tracks whether patients have taken their medications and helps them stay adherent to their prescription schedule. The system has been clinically reviewed, validated by the pharmaceutical industry, and integrated into patient care programs throughout Canada and Europe, with opportunities to expand further into North America and other regions.
Providing guidance on dealing with cancer
In 2018, Janssen Oncology debuted a novel way to help support patients with the launch of Cancer.com, a one-stop digital destination designed to help guide patients and caregivers through many of the decisions they must make when faced with the disease. Guided by our mission to provide patients and caregivers with up-to-date cancer resources and information, Cancer.com helps patients find information they want about their disease and receive tailored content related to their own cancer diagnosis.
Advancing patient engagement industry-wide
For the past 15 years, EyeforPharma’s annual Patient Summit Europe has been a key event, bringing together patient advocates and industry representatives to discuss advancing patient engagement and advocacy across the health sector. In 2018, more than 300 delegates attended the summit in London, including two keynote speakers and several delegates from Johnson & Johnson.