Insight Category: News

For too long, low- and middle-income countries (LMICs) have borne the brunt of global health disparities— accounting for over 80% of the world’s population and more than 90% of its disease burden—yet representing a mere 6% of global pharmaceutical revenue. Equitable access to high quality affordable medicines remains a daunting task, and addressing this challenge has never been more critical. Axmed, an innovative two-sided B2B marketplace platform, is taking a bold and meaningful step forward in addressing this disparity with the announcement of a $2 million seed funding round. This investment aims to accelerate the affordability, availability, and distribution of essential and innovative medicines in underserved regions.

The fresh investment was led by Founderful Ventures and complements an earlier $5 million in grant funding from the Bill and Melinda Gates Foundation, bringing total funds raised to $7 million. These funds will bolster Axmed’s expansion, enhancing its engineering and commercial teams and advancing its technology infrastructure to initiate operations in strategically selected markets within Africa and the Caribbean.

Axmed’s B2B marketplace optimises the procurement process for healthcare providers in emerging and growth markets, catering to public, third sector, and private entities. The platform aggregates demand for both off- patent and patented medicines, creating larger, more cost-effective order volumes for manufacturers while simultaneously enhancing buyer leverage on cost and availability. The platform further streamlines the process by curating and consolidating Requests for Proposals and efficiently mapping out supply logistics. This approach creates a win-win outcome: it lowers the barriers to accessing costly medicines for patients and providers, while enabling manufacturers to expand their footprint in underserved markets.

Axmed’s founding team brings together a wealth of expertise and dedication, with over 30 years of collective experience in healthcare, finance, and public-private partnerships. CEO Emmanuel Akpakwu, previously Chief Commercial Officer for Novartis AG’s Sub-Saharan Africa operations, is joined by Felix Ohnmacht and Sofia Radley-Searle, who have held key positions at Novartis and GSK, respectively. Their united vision is to tackle healthcare inequity head-on.

Emmanuel Akpakwu, CEO of Axmed commented: “We are not merely developing a medicines platform; we are creating a bold new vision for the future of medicine accessibility. This vision not only empowers buyers but also unlocks the full potential of growth markets, allowing suppliers to compete effectively.”

This seed round propels Axmed into its next phase of strategic expansion, driving significant advancements in building out the engineering and business development teams, whilst preparing the platform for launch. Through targeted deployment of funds, Axmed will enhance its marketplace technology and forge alliances with key healthcare stakeholders to ensure a reliable supply of critical medicines.

“We’re delighted to back this outstanding team,” added Lukas Weder, Founding Partner at Founderful. “The team’s commitment and enthusiasm for addressing this important challenge is inspiring. We have every confidence in their ability to reshape the $140 billion LMIC pharma market, improving access to medicines for over 6 billion individuals. ”

Axmed’s mission extends beyond technology; it’s about forging critical partnerships and ensuring a steady flow of crucial medicines to those in need. Despite LMICs’ small share of the global pharmaceutical market, they represent a burgeoning $140 billion sector, with Africa alone accounting for over $43 billion in pharmaceutical opportunity. The urgency for accessible and affordable healthcare solutions has never been more evident, especially in the wake of the COVID-19 pandemic, which highlighted the need for a coordinated and sustainable medicines marketplace tailored to LMICs.

“Industry leaders and healthcare providers are aligned in their support for Axmed’s model, recognizing its potential to significantly enhance medicine accessibility in Low and Middle-Income Countries. “Axmed’s approach could fundamentally change how patients obtain treatments,” remarked Roselyne Opel, Head of the Organisation of Eastern Caribbean States Pooled Procurement Initiative (OECS PPI). “We look forward to seeing their platform reshape access, empowering buyers and strengthening supply of lifesaving therapies to a broader patient base.”

James Nyamongo, CEO of the Nairobi Hospital, Kenya added: “Axmed’s approach not only empowers us to gain access to life-saving medicines affordably, it also fosters real competition that raises the quality bar, bringing the highest quality local and global manufacturers to our doorstep”.

As the deadline for the UN Sustainable Development Goals approaches, Emmanuel Akpakwu reaffirms Axmed’s commitment: “We are driven by the belief that radical solutions are necessary to build on the progress being made across the various facets of global health. Axmed represents such a solution, and we are eager to make a positive, lasting impact on the world.”

Thibaud Lefort, Head of Operations for Sanofi’s Global Health Unit, added: “Axmed’s model presents a powerful opportunity to deliver much needed positive change across global health. We are eager to see their platform transform the access landscape, improving supplier-ability to reach more patients with lifesaving therapies, especially in underserved environments”

About Axmed

Axmed is an innovative healthcare venture focused on transforming access to medicines across low- and middle-income countries (LMICs). Through its robust digital platform, Axmed operates a two-sided B2B marketplace that bridges the gap between pharmaceutical manufacturers/suppliers and healthcare providers, ensuring a steady, affordable supply of critical medicines. By leveraging technology, strategic partnerships, and a deep understanding of the unique challenges faced by LMICs, Axmed is committed to fostering sustainable health outcomes and accelerating global health equity.

About Founderful

Founderful is Switzerland’s leading pre-seed fund. We give every founder our deepest understanding and highest levels of support, and together, we’re building the future of the Swiss startup ecosystem.

Contact Details

Axmed

Bilal Mahmood

+44 7714 007257

b.mahmood@stockwoodstrategy.com

Company Website

https://www.axmed.com/

Grant funding from the Bill & Melinda Gates Foundation targets improving access to essential medicines for the Maternal, Newborn, and Child Health (MNCH) Population starting in Sub-Saharan Africa

[Cambridge, MA, USA | Basel , Switzerland, 1st November 2023]

AxmedRx, a Public Benefit Corporation actively engaged in delivering global healthcare solutions, is proud to announce the receipt of a USD 5 million grant from the Bill & Melinda Gates Foundation. The funds will be dedicated to the strategic deployment and expansion of AxmedRx’s innovative two-sided medicines marketplace, with a specific focus on accelerating access to vital treatments for the MNCH population starting in sub-Saharan Africa.

“The grant marks a transformative era in AxmedRx’s approach to tackling the stark healthcare disparities in underserved populations. It’s more than financial support — it’s an affirmation of trust in our mission, vision, and capacity for significant impact,” expressed Emmanuel Akpakwu, CEO of AxmedRx. “With these resources, we’re poised to spearhead meaningful change, prioritizing the health of mothers and newborns who are often the most vulnerable.”

Dr. Patrice Matchaba, a member of the AxmedRx Advisory Board, highlighted the urgency of the initiative, saying, “This collaboration is a bold step toward global health equity. The COVID pandemic has unfortunately contributed to a reversal of previous gains in maternal and newborn health in developing countries. We must act now to prevent further loss of lives during pregnancy and childbirth from preventable and treatable causes.”

The grant will empower AxmedRx to expand healthcare access by fostering strategic alliances with key players in the industry, including healthcare stakeholders, governmental representatives, and pharmaceutical companies. Envisioned outcomes include strengthening procurement capability for buyers, fortifying healthcare systems, and establishing a coalition of logistics players capable of safe, secure, and transparent delivery of medicines to the final mile.

“Our strategy is grounded in actionable plans, local collaboration, and an in-depth understanding of the distinct health challenges each region faces,” stated Chief Operating Officer Sofia Radley-Searle. “This grant empowers us to deploy our resources and creativity to initiate a health revolution that will resonate across communities.”

Felix Ohnmacht, Chief Commercial Officer, emphasized the project’s alignment with AxmedRx’s long-term vision: “We’re on a humanitarian quest, not just a commercial one. We’re committed to building sustainable, robust health systems. Our commercial endeavors are intertwined with our commitment to effecting real change.”

“Our initiative embodies hope and actionable change. Together, we are creating a world where essential healthcare is accessible, regardless of geographical location or economic status,” Emmanuel Akpakwu concluded.

AxmedRx is appreciative of the Bill & Melinda Gates Foundation’s support, and invites the participation of media partners, global health proponents, healthcare providers, and pharmaceutical partners in this transformative endeavor.

For more information, interview requests, or media inquiries, please contact: info@axmedrx.com

About AxmedRx: AxmedRx is an innovative healthcare venture focused on revolutionizing access to essential medications in low- and middle-income countries (LMICs). Through its robust digital platform, AxmedRx operates a two-sided marketplace that bridges the gap between pharmaceutical suppliers and healthcare providers, ensuring a steady, affordable supply of critical medicines. With a starting emphasis on maternal, newborn, and child health (MNCH), AxmedRx not only strives to mitigate the prevalent healthcare disparities in LMICs but also aims to fortify the medical supply chain, making healthcare more accessible, efficient, and cost-effective. By leveraging technology, strategic partnerships, and a deep understanding of the unique challenges faced by LMICs, AxmedRx is committed to fostering sustainable health outcomes and accelerating global health equity.

Manufacturers showed during the pandemic that they can deliver low-cost treatments at scale.

The Covid-19 pandemic underscored the urgent need for equitable access to medicine. But when it comes to expanding access, the pivotal role of the world’s generic medicine manufacturers often slips under the radar. This is despite the fact that the global market was worth $311.8bn in 2022, and is projected to hit $442.3bn by 2027.

It is often assumed that generic drugs are affordable and widely available to those who need them. But this is not entirely true. For example, even after patent expiries open the door to generic rivals, low levels of competition between companies in smaller markets means that generics can actually be more expensive in poor countries than in wealthy ones.

Many essential generic medicines are also often absent from pharmacy shelves in poorer countries, particularly in rural and remote areas — frequently with devastating results.

Today, generics are a cornerstone of health systems. Ninety per cent of the medicines included on the World Health Organization’s Model List of Essential Medicines are off-patent, meaning companies can make their own versions of these key products.

The huge footprint of the sector gives it a correspondingly huge importance in addressing the issues that leave millions of people worldwide without access to the treatments they need. Generics companies must now make a conscious effort to address global health challenges and realise their potential as key players in access to medicine.

We know this is possible, because generics companies are already experts at delivering lower-cost treatments at scale, and have stepped up previously to address urgent issues. Early in the Covid pandemic, for example, manufacturers leveraged their production capacity to respond rapidly, ensuring that many existing medicines remained available despite global supply chain disruptions.

Such efforts undoubtedly saved many lives — but they remain exceptional. To remedy this, the Access to Medicine Foundation has developed a new analytical framework to guide generic medicine manufacturers in converting exceptions into the rule. Initially, the framework will be used to assess the efforts of five companies: Cipla, Hikma, Sun Pharma, Teva and Viatris.

We are at an important moment in the generics industry’s development, as there are many opportunities for companies to seize, from working with local manufacturers to improve supply in low- and middle-income countries, to investing in adaptive research and development.

There are also more opportunities to engage in licensing agreements, through which the big pharmaceutical groups allow generics companies to launch versions of their on-patent medicines. With Big Pharma increasingly issuing these licences, including the first covering a cancer drug, generics companies have both a business opportunity and a chance to expand patients’ access to innovative medicines.

There are further opportunities in the market for biosimilars — copies of biological drugs — with their global market value projected to rise to $60.8bn in 2027. Biosimilar medicines first arrived on the scene over a decade ago, but the market has recently gained momentum with the expiry of patents on blockbuster biological drugs and with the WHO’s expansion of its prequalification assessment scheme to include a number of biosimilars. Although these drugs have yet to make significant inroads in low and middle-income countries compared with high-income ones, they offer great potential if access barriers can be broken down.

Generic medicine manufacturers have a central role to play in expanding access to medicine. Now is the time for them to explore the opportunities that will ensure people around the world gain access to the medicines they need.

Patients in the developing world often face prices for essential medicines far in excess of international reference levels, even if those drugs have lost patent protection. This column presents evidence from seven low- and middle-income countries with diverse drug procurement systems to assess the effect of centralised procurement on drug prices. The results of the study highlight that centralised procurement of drugs by the public sector leads to lower prices, but that the induced price reduction is smaller when the supply side is more concentrated.

Across low- and middle-income countries, the prices of essential medicines, such as cancer treatments, HIV antiretrovirals, and antibiotics, display substantial variations, with the locally observed prices sometimes being many times higher than the lowest international reference level for generic equivalents. Chalkidou et al. (2020) show that some purchasers in low- and middle-income countries pay up to 30 times the minimum international reference price for basic generic medicines, such as paracetamol, insulin, and omeprazole. High prices, in turn, deplete already-limited public health budgets and generate shortfalls in access, especially for the poorest and neediest members of society.

Existing economic research has addressed the issue of affordable access to drugs in developing countries mostly from a patent protection angle. Several authors have analysed the trade-off between the potential costs of restrictive patent policies (due to the higher prices resulting from monopolistic pricing policies) and the potential benefits related to the faster diffusion of new drugs to markets enjoying stronger patent protection (Chaudhuri et al. 2006, Kyle and Qian 2014, Cockburn et al. 2016).

However, most spending on health products in these countries goes to off-patent branded generics, for which patents cannot explain the large markups being charged. Instead, important potential sources of friction in local drug markets are likely to involve suppliers\’ market power and buyers\’ size, as well as the type of procurement mechanisms used by public buyers. Understanding price variations and formulating policy recommendations for better and cheaper access to drugs in developing countries requires analysing the market structure for drug procurement.

In a new paper (Dubois et al. forthcoming), we analyse the impact of procurement mechanisms and supply-side concentration on drug purchase prices in low- and middle-income countries. These countries use a variety of procurement mechanisms including centralised public procurement with or without central medical stores, decentralised public procurement, and private procurement. One key mechanism that has been used to attempt to reduce unit purchase prices (which impact we test in this paper) is ‘pooled procurement’, whereby several buyers – either institutions in a single country or health agencies across countries – consolidate their purchases.

First, we develop a model in which several firms offer differentiated products through a procurement process that can be either centralised or decentralised. We assume that public buyers are price-takers when buying in a decentralised manner (an appropriate assumption in the context of drug procurement in low- and middle-income countries), but become non-price-takers when procurement is centralised (i.e. when they are able to get together to bargain with suppliers). Under fairly general assumptions, we show that prices under centralised procurement are lower than prices under decentralised procurement.

We then use data from seven low- and middle-income countries with diverse drug procurement systems to evaluate empirically which procurement mechanisms allow countries to access drugs at lower prices. Specifically, we use data from IMS Health (IQVIA) that exhaustively cover the sales quantities and expenditures of drugs for 40 essential molecules across 16 therapeutic areas at a finely disaggregated level (by year and sector of purchase during the period 2015-2017). Previous studies relied on limited sets of drugs with specific characteristics, mostly those targeting infectious diseases such as HIV/AIDS, tuberculosis and Malaria – diseases which are at the centre of attention for global health advocates and dedicated international organisations. This narrow scope limits the external validity of their findings. Instead, we consider a much larger variety of drug classes, also including, for example, antibiotics, antihypertensives, and contraceptives. Generic availability is the case for 33 out of these 40 molecules (over 95% of the observations in our sample).

The countries included in our analysis are India (in particular, Kerala), the Philippines, Senegal, Serbia, South Africa (a subset of three States: KwaZulu-Natal, North West, and Eastern Cape), Tunisia, and Zambia. There is rich variation in terms of the way drugs are procured, both across and within these countries. For three of the countries in our sample (the Philippines, Serbia, and South Africa), the channels of drug procurement even vary within specific therapeutic areas. For example, specific HIV antiretrovirals are purchased centrally, while others are purchased in a decentralised manner. We also observe different purchase mechanisms being used simultaneously within molecules. This is seen mostly in public and private procurement, but also in public centralised and decentralised procurement, in some cases.

Our empirical strategy relies on exploiting this within-molecule country-year variation. The identification is possible because, for a subset of molecules in some countries, purchases are made simultaneously through the different channels (public centralised, public decentralised, and private). There might also be within-molecule country-year differences in prices at the product-level, because there are often several manufacturers offering different brands of the same generic molecule. This could drive differences in prices through quality or if centralised procurement was targeting specific and cheaper formulations. We address these concerns by adding product fixed effects. Finally, we use a selection correlation procedure to address the concern that there might be a systematic bias in the choice of procurement mechanisms and, in particular, of which molecules are procured centrally.

In addition, the concentration of suppliers also varies substantially across countries and therapeutic areas, from single seller situations to highly competitive environments. We estimate the role of suppliers’ concentration by interacting the purchase mechanisms with within-therapeutic areas’ ‘Herfindahl-Hirschman Indexes’, which we instrument following classic methods in the industrial organisation research.

Consistent with the model’s predictions, our main finding is that centralised procurement of drugs allows the public sector to obtain much lower prices. In our most stringent specification, with product fixed effects and selection correction, we find that centralised public procurement commands a 15% price reduction on average. However, we also find that the reduction is smaller when the supply side is more concentrated. At the extreme, instrumenting the supply side concentration, we show that the price difference vanishes when public buyers face a supplier market with an Herfindahl-Hirschman Index value above 46% (which is approximately the 80th percentile of the distribution).

The price reductions found in this paper may be driven by two complementary mechanisms. First, demand-side concentration may enhance public buyers\’ bargaining power, allowing them to extract lower prices (all else being equal). In addition, centralised procurers are likely to buy larger quantities, securing price discounts on larger orders in doing so. These two channels are hard to disentangle, as they occur simultaneously. Further research is needed to identify the nature of market interactions between buyers and sellers and to separate their effect from that of transaction size.

Finally, our results have important policy implications regarding supply-side concentration. Indeed, simple reduced-form estimations of the impact of increasing supply-side competition show large potential increases in the quantity of drugs that public sectors could purchase for a given budget.

References
Chaudhuri, S, P K Goldberg and P Jia (2006), “The Effects of Global Patent Protection in Estimating Pharmaceuticals: A Case Study of Quinolones in India”, American Economic Review 96: 1477-1514.

Chalkidou, K, J M Keller, M Over and A Jones (2020), “Can Better Procurement be the Key to Financing UHC? Potential Savings from Health Sector Procurement Reforms in Low- and Middle-Income Countries”, CGD Policy Paper 192, Washington DC.

Cockburn, B I M, J O Lanjouw and M Schankerman (2016), “Patents and the Global Diffusion of New Drugs”, American Economic Review 106 (1): 136-164.

Dubois, P, Y Lefouili and S Straub (forthcoming), “Pooled Procurement of Drugs in Low and Middle Income Countries”, European Economic Review.

Kyle, M and Y Qian (2014), “Intellectual Property Rights and Access to Innovation: Evidence from TRIPS”, working paper.

FDA NEWS RELEASE

Today, the U.S. Food and Drug Administration approved Leqembi (lecanemab-irmb) via the Accelerated Approval pathway for the treatment of Alzheimer’s disease. Leqembi is the second of a new category of medications approved for Alzheimer’s disease that target the fundamental pathophysiology of the disease. These medications represent an important advancement in the ongoing fight to effectively treat Alzheimer’s disease.

“Alzheimer’s disease immeasurably incapacitates the lives of those who suffer from it and has devastating effects on their loved ones,” said Billy Dunn, M.D., director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research. “This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer’s, instead of only treating the symptoms of the disease.”

Alzheimer’s disease is an irreversible, progressive brain disorder affecting more than 6.5 million Americans that slowly destroys memory and thinking skills and, eventually, the ability to carry out simple tasks. While the specific causes of Alzheimer’s are not fully known, it is characterized by changes in the brain—including amyloid beta plaques and neurofibrillary, or tau, tangles—that result in loss of neurons and their connections. These changes affect a person’s ability to remember and think.

Leqembi was approved using the Accelerated Approval pathway, under which the FDA may approve drugs for serious conditions where there is an unmet medical need and a drug is shown to have an effect on a surrogate endpoint that is reasonably likely to predict a clinical benefit to patients. The results of a Phase 3 randomized, controlled clinical trial to confirm the drug’s clinical benefit have recently been reported and the agency anticipates receiving the data soon.

Researchers evaluated Leqembi’s efficacy in a double-blind, placebo-controlled, parallel-group, dose-finding study of 856 patients with Alzheimer’s disease. Treatment was initiated in patients with mild cognitive impairment or mild dementia stage of disease and confirmed presence of amyloid beta pathology. Patients receiving the treatment had significant dose- and time-dependent reduction of amyloid beta plaque, with patients receiving the approved dose of lecanemab, 10 milligram/kilogram every two weeks, having a statistically significant reduction in brain amyloid plaque from baseline to Week 79 compared to the placebo arm, which had no reduction of amyloid beta plaque.

These results support the accelerated approval of Leqembi, which is based on the observed reduction of amyloid beta plaque, a marker of Alzheimer’s disease. Amyloid beta plaque was quantified using positron emission tomography (PET) imaging to estimate the brain levels of amyloid beta plaque in a composite of brain regions expected to be widely affected by Alzheimer’s disease pathology compared to a brain region expected to be spared of such pathology.

The prescribing information for Leqembi includes a warning for amyloid-related imaging abnormalities (ARIA), which are known to occur with antibodies of this class. ARIA usually does not have symptoms, although serious and life-threatening events rarely may occur. ARIA most commonly presents as temporary swelling in areas of the brain that usually resolves over time and may be accompanied by small spots of bleeding in or on the surface of the brain, though some people may have symptoms such as headache, confusion, dizziness, vision changes, nausea and seizure. Another warning for Leqembi is for a risk of infusion-related reactions, with symptoms such as flu-like symptoms, nausea, vomiting and changes in blood pressure. The most common side effects of Leqembi were infusion-related reactions, headache and ARIA.

As specified in the prescribing information, Leqembi is indicated for the treatment of Alzheimer’s disease. The labeling states that treatment with Leqembi should be initiated in patients with mild cognitive impairment or mild dementia stage of disease, the population in which treatment was studied in clinical trials. The labeling also states that there are no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied.

The FDA granted this application Fast Track, Priority Review and Breakthrough Therapy designations.

The approval of Leqembi was granted to Eisai R&D Management Co., Ltd.

Related Information

• Alzheimer’s Disease
• Approved Drugs: Questions and Answers
• Accelerated Approval Program

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The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

The 2022 Access to Medicine Index finds that since the COVID-19 pandemic hit, more pharmaceutical companies have stepped up to make some of their products more widely accessible in low- and middle-income countries (LMICs). If the pandemic is to be a turning point in the fight for equitable access to medicine, companies must now scale their efforts to cover more products in their portfolios, and in a greater number of countries.

Pharmaceutical companies invest heavily in R&D in order to discover and develop new drugs that can be brought to market. The R&D process can be very expensive and time-consuming, often taking many years and requiring significant investment in clinical trials, regulatory compliance, and marketing. As a result, the cost of developing a new drug can run into billions of dollars.

In February 2021, it was reported that drug shortages in South Africa had worsened due to a combination of factors, including the COVID-19 pandemic, a lack of investment in local manufacturing, and regulatory delays.

The shortages have affected both essential medicines and drugs used to treat COVID-19. For example, some hospitals were reportedly running out of oxygen supplies, while others were experiencing shortages of painkillers, antibiotics, and other critical drugs. The situation was particularly acute in rural areas and townships, where healthcare infrastructure is often under-resourced and overburdened.

According to the South African Health Products Regulatory Authority, the COVID-19 pandemic has disrupted global supply chains and led to shortages of raw materials, which has in turn affected the production and distribution of medicines. In addition, the agency noted that there has been a lack of investment in local manufacturing, which has made the country more dependent on imports.

The regulatory delays have also been a factor in the drug shortages. For example, some pharmaceutical companies have faced delays in getting approval for their products, which has led to supply chain disruptions and shortages.

The South African government has acknowledged the severity of the drug shortages and has taken steps to address the problem. In March 2021, President Cyril Ramaphosa announced a plan to invest in local pharmaceutical manufacturing, with the aim of reducing the country’s reliance on imports. The government has also established a task force to address the drug shortages and ensure that essential medicines are available to those who need them.

Overall, the drug shortages in South Africa have highlighted the need for greater investment in healthcare infrastructure and local manufacturing, as well as more effective regulatory processes to ensure that essential medicines are available to all who need them.