(Bloomberg) -- Efforts by major generic drugmakers to expand access to essential medicines have fallen short for many of the world’s poorest patients, a new study found. 

Only one of out 50 products made by five large generic drug makers — Cipla Ltd., Hikma Pharmaceuticals Plc, Sun Pharmaceutical Industries Ltd., Teva Pharmaceutical Industries Ltd. and Viatris Inc. — had a pricing strategy that took into account a patient’s ability to pay in low-to-middle income nations, according the report from the Access to Medicine Foundation.  

Many remain out of reach for the impoverished and uninsured, even though 41 of the 50 drugs have expanded access plans, the foundation said. More broadly, the drugmakers made a huge impact with the essential medicines they produced, with treatments registered in 90 out of 108 countries, the report found.

Clear opportunities exist for companies to ramp up their efforts and make it easier for millions of people who lack adequate access to care to get the medicines they need, said Claudia Martinez, a research manager for the foundation’s generic and biosimilar medicines program. 

Race to the Bottom

While the report flagged cost concerns, generic drug prices have plummeted over the past decade. The race to the bottom led two US generic manufacturers to file for bankruptcy this year and Tel Aviv-based Teva announced plans in May to stop producing some less profitable products. 

“If you keep on putting pressure on generic pricing, what will happen?” Sudarshan Jain, the secretary general of the Indian Pharmaceutical Alliance — which represents many of the country’s biggest drugmakers — said in an interview in Mumbai on Tuesday. “Either the quality will suffer or the access will suffer.”

Over the past year, India’s $50 billion pharmaceutical sector has been rocked by a series of global medicine tragedies, including the deaths of dozens of children linked to adulterated cough syrup exported by small, privately-held drugmakers in the country.

The highly regulated US remains the key market for most major generic players. Access to Medicine said firms targeting the most lucrative countries might not sell in poorer ones, making availability another major barrier to access.

“When it comes to expanding access to medicine, the power of the generics industry is often underestimated,” said Jayasree K. Iyer, the foundation’s chief executive officer. 

“It’s more than the transactional relationship of selling drugs at volume and competing on price,” she said, adding that companies should work with local manufacturers to improve supply and safeguard quality. “Companies must engage with the unmet medical need globally.” 

The report was released Tuesday by the foundation, whose funders include Axa Investment Managers, the Bill & Melinda Gates Foundation, and the Dutch and UK governments.

(Updates with comments from Access to Medicine’s CEO in penultimate paragraph.)

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