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Clues on Equity Engagement Levels

Pharmaceutical ExecutivePharmaceutical Executive: February 2023
Volume 43
Issue 02

A survey of 18 biopharmas, measuring their scope and implementation across key health equity dimensions and activities, uncovers useful context as companies seek better alignment of these goals with overall strategy.

Health equity has become top-of-mind both for the general public and biopharmaceutical organizations in recent years, not least due to COVID-19, racial and gender equity movements, and the resulting need to refine environmental, social, and governance (ESG) strategies. With this in mind, Boston Consulting Group (BCG) set out to better understand the current landscape of how health equity is addressed in biopharma by conducting a study with 18 global drug manufacturers across five dimensions:

  • Strategy. Have biopharma companies articulated health equity strategies, and what is their scope?
  • Product-level implementation. How and at what stages of the product life cycle are health equity considerations integrated?
  • External ecosystem engagement. How do companies engage with the ecosystem and think about partnering?
  • Metrics and reporting. What types of metrics are tracked systematically, and how are they reported?
  • Operating model. How are health equity roles and responsibilities anchored, and how do teams collaborate?

Insights on these topics were gathered via a survey filled out by key health equity representatives within the company and structured 1-on-1 interviews with more than 40 participants across the 18 companies. The survey was conducted from May to October 2022.

Health equity in biopharma is nascent, with significant efforts to ramp up strategy

Out of the 18 companies surveyed, 15 had a global policy position on health equity in place; two companies, instead, had set up regional and functional health equity mandates; and only one organization had no formal position but planned to complete one within the next six months. The majority (15 out of 17) of these policy positions had been set up in the past five years, and all had been recently updated. Health equity mandates were typically integrated within both ESG and corporate social responsibility (CSR) mandates (11 of 17) or in ESG alone (3 of 17), while three companies did not connect health equity with either ESG or CSR. Additionally, more than half of the companies included in the study have formal plans to include health equity goals in their strategy (11 of 18).

Overall, there has been a rapid increase in general awareness and willingness to create structured programs. Biopharma companies have not yet agreed on a unified formal understanding of the scope of health equity for industry, but when surveyed on health equity policies and programs they systematically engage in, there was a high degree of overlap.

In addition to corporate-level policy positions, companies report an increasing need to articulate specific geographic, functional, disease area, or product-related health equity positions. Geographic mandates are deployed to detail approaches for regional contexts with differentiated needs, such as specific population segments within higher-income countries (e.g., Black populations in the US) or to expand access and uptake to lower income countries (9 of 17).

Some companies also established functional positions to clarify responsibilities between the diverse teams required to operationalize health equity (10 of 17). Disease area or product mandates address disease-related equity challenges, such as vaccine rollout in lower- and middle-income countries or rural care infrastructure requirements for oncology (10 of 17). Companies with portfolios requiring a more cognizant approach to equitable access and uptake, such as those with women’s health or infectious disease products, tend to be early movers in formalizing specialized mandates, while no company has set up specialized positions for the full portfolio to date.

A key concern echoed by many respondents is the need to raise organizational awareness and better understand the required capabilities needed to drive health equity initiatives. Half of the companies have developed health equity-related trainings, and many others plan to roll out training programs soon. Among those who offer training, there is a diversity of approaches, with the majority integrating health equity into diversity, equity, and inclusion (DE&I) trainings, ESG modules, or access and pricing modules. Only two companies reported dedicated, function-specific health equity trainings, while many others plan to do so in the future.

Product-level implementation

Corporate-level statements can be operationalized at the product level across the full life cycle through diverse policies and programs. During portfolio prioritization, budget commitments, and R&D, targets for novel products addressing the unmet needs of underserved populations can be set up alongside equity-related prioritization criteria. Ensuring that products are designed with the specific needs of underserved populations in mind, such as appropriate formulations (e.g., shelf-stability without cold storage in case cooling infrastructure is not available) and dosage (e.g., longer dosage cycles to account for more difficult access to treatment) can further help bridge the gap. During development, ensuring inclusive clinical trial populations that represent the target population is a key concern.

To support patient availability and uptake, supply chain stability, and distribution infrastructure, broad filing and licensing commitments based on unmet medical need and commitments to achieve affordable access in underserved markets can be tackled. Finally, dedicated outreach and awareness efforts, healthcare provider (HCP) education, and general health system-strengthening activities tailored to underserved population segments can aid demand creation.

All 18 companies report initial efforts to integrate health equity considerations at a product level; however, this integration remains fragmented. There is a growing drive to become more systematic, particularly within clinical trial operations and market access. But no company has yet achieved a systematic integration of health equity considerations across the life cycle for a single product or systematically within a segment (e.g., access) for all products. Commitments and related guidance to reach these goals tend to be at a high level and would benefit from a more systematic and cross-functional approach.

External ecoystem engagement

The complexity of addressing underlying health equity drivers has prompted industry to increasingly look toward effective partnering strategies, with all 18 companies actively engaged in broad partnerships within and beyond healthcare. Frequently-voiced objectives include the need to access local expertise for rollout, share relevant capabilities, and address social drivers of health equity beyond the scope of biopharma, such as through educational outreach, community programs, and supply chain infrastructure in lower income countries.

High interest to do more collaborative work within the biopharma industry was recorded, as companies tend to invest resources on common causes of health disparities but lack the overarching coordination to optimize results, lack a common language and narrative, and have no established sharing platforms to exchange best practices. The majority (13 of 18) companies survey present at external conferences, but concerns were raised regarding the ability of biopharma to clearly voice its role and contributions within the health equity space. Nevertheless, contributors recognize biopharma’s unique potential role as an orchestrator of health equity conversations across a broad range of stakeholders (e.g., governments, patient advocacy groups, payers, providers, global organizations) if the industry were to approach the topic more systematically.

Metrics and reporting

Health equity measurements are at an early stage within industry. In our survey, most companies (16 of 18) indicated they track some related metrics, such as the number of patients benefitting from patient support programs, donations, and philanthropic programs as well as the total number of patients treated. However, all companies voiced methodology and data privacy challenges in assessing this across equity dimensions such as income, race, or gender. Thirteen companies additionally track efforts around health system strengthening—but often with vastly different metrics behind them. Biopharma lacks a commonly agreed-upon measurement framework and approach for health equity, and grapples with navigating increasingly restrictive data protection regulations, which, so far, have prevented the reporting of metrics across equity dimensions.

Dedicated efforts to better tailor health equity measurements are well underway through various academic partnerships, and it can be expected that first movers will launch attempts at segmenting patient groups based on unmet needs and equity considerations soon.

In line with the absence of a rigorous methodology, most organizations do not have dedicated, regular reports on health equity. Eight companies have released external health equity communications, but the scope and data-driven nature of these reports is highly variable. Currently, formal health equity reporting is embedded within ESG reporting, with all surveyed companies reporting health equity-related key performance indicators in their 2021 ESG reports. However, of the 20-plus metrics listed in these reports, most organizations only report four to five, and the underlying measurement and reporting approaches vary significantly.

Operating model

All companies reported recent internal efforts to systematically organize health equity roles and responsibilities in line with corporate health equity targets and strategies in a wide range of potential operating models. Despite many ongoing initiatives, coordination across functions remains the key issue to solve for.

Two companies have not yet formalized responsibilities for health equity roles. Of those with formalized roles, eight share responsibilities across existing groups and are currently investigating how to integrate cross-functional perspectives optimally. Six have mandated one of the existing involved teams with a major role in driving health equity initiatives, and two have recently set up dedicated health equity units.

Teams involved, much like the operating models chosen, vary widely dependent on geographic reach, portfolio needs, and product-level integration of health equity considerations. Beyond the two companies reporting new health equity teams, major mandates were frequently allocated to global health units, advocacy, ESG/CSR/sustainability offices, market access and pricing, or regions (for local implementation). Contributing teams include the above mentioned as well as corporate functions
(e.g., communications, marketing, HR, and DE&I), public and governmental affairs, medical, R&D, and product teams.

No single company reported the same health equity setup, and many voiced interests in jointly examining suitable organizational models. The complex nature of the topic is also reflected in how it is handled within biopharma and the complexity that is inherent in coordinating the efforts. This is also reflected in the number of employees engaged within health equity across the different companies. It varies broadly across our survey, with the majority (12 of 18) reporting less than five employees and three early movers reporting team sizes above 20 full-time employees.

All reported efforts in five focus areas

Industry representatives responding to our survey expressed five key areas of focus going forward. These are areas where they are deploying significant, systematic efforts to formalize and map out their health equity roles and contributions:

  1. Strategy integration. Effectively balancing health equity goals with overarching strategy, set suitable health equity goals tailored to the portfolio, and anchor these considerations within ESG and CSR agendas.
  2. Measurement framework. Defining which metrics are suited to measure and track health equity across geographies and portfolio, and developing datasets and sensible targets.
  3. Clinical trial diversity. Understanding disease populations across health equity dimensions, and ensuring representative diversity within clinical trials.
  4. Approach to LMICs. Developing access to medicine programs and differential pricing, and launching region-specific programs to remove barriers to access, such as lack of healthcare infrastructure.
  5. Role of biopharma in the ecosystem. Understanding the role of biopharma in advancing health equity, and partnering with the right stakeholders to coordinate effective initiatives.

What’s next: High interest in cross-industry collaboration

Across the board, biopharma industry representatives voiced a huge need to establish an exchange forum on health equity to share experiences and jointly develop ideas. There is an understanding that a coalition addressing common topics of concern (e.g., rare diseases, infrastructure in low- and middle-income countries) would enable more impactful solution design and deployment by sharing relevant know-how, best-practices, and capabilities.

The forum could be leveraged to identify meaningful health equity metrics; monitor progress toward health equity; illustrate what industry is doing today; and assist with identifying suitable partners within and beyond healthcare.

Additionally, organizational topics and themes such as health equity operating models and defining a common scope and view on health equity domains would better align language and boost effectivity.

Jens Grueger, director for market access and pricing in healthcare and BCG Henderson Institute fellow, Sabine Hain, BCG Henderson Institute ambassador, and Srikant Vaidyanathan, managing director, senior partner, and BCG Henderson Institute fellow; all with Boston Consulting Group

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