Strategic Access Models for Multinational Pharmaceutical Companies to Expand Access to Innovative Medicine in Emerging Markets: An Equity-Based Approach
Main Article Content
Multinational pharmaceutical companies in emerging markets often face strategic failures due to rigid global governance and pricing models that force them into either premium pricing or cost leadership, with no viable middle-ground strategy. These challenges are worsened by delayed product launches and over-reliance on government tenders for patient access. In Indonesia, JKN policies prioritizing cost containment over clinical innovation further intensify these difficulties. This research aims to analyze the strategic challenges faced by pharmaceutical MNCs in emerging markets, formulate adaptable business-level strategies, and assess the feasibility of innovative financing solutions, particularly equity-based pricing, to promote equitable access to medicines. Using a qualitative exploratory design guided by Design Thinking, the research employed strategic management frameworks including Porter's Five Forces, Resource-Based View (RBV), and Strategic Entrepreneurship. Data were collected through semi-structured interviews with industry stakeholders and triangulated with secondary sources. Thematic analysis was conducted using NVivo software. Strategic ideation explored innovative access models such as equity-based pricing. Prototypes were evaluated through scenario modeling and stakeholder feedback, demonstrating strong feasibility as a scalable solution. Findings emphasize that success in emerging markets requires MNCs to abandon strategic arrogance and rigid global playbooks in favor of localized, collaborative, and adaptable strategies.
Antonanzas, F., Juárez-Castelló, C., Lorente, R., & Rodríguez-Ibeas, R. (2019). The use of risk-sharing contracts in healthcare: Theoretical and empirical assessments. PharmacoEconomics, 37(12), 1469–1483. https://doi.org/10.1007/s40273-019-00838-w
Arnabal, L. R. (2021). Optimal design of sin taxes in the presence of nontaxable sin goods. Health Economics, 30(7), 1580–1599. https://doi.org/10.1002/hec.4269
Berndt, E. (2018). Innovation and pricing in pharmaceuticals. Journal of Economic Perspectives, 32, 45–66. https://doi.org/10.1257/jep.32.4.45
Chandra, A., & Garthwaite, C. (2017). The economics of indication-based drug pricing. New England Journal of Medicine, 377(2), 103–106. https://doi.org/10.1056/NEJMp1705035
Chidavaenzi, G. T., Salie, F., & Grobbelaar, S. S. (2025). Designing and implementing outcome-based models in healthcare: Insights and strategies from a scoping review. Management Review Quarterly. https://doi.org/10.1007/s11301-025-00542-4
Claxton, K., & Palmer, S. (2017). Value-based pricing in health care systems. Health Economics, 26, 1–12. https://doi.org/10.1002/hec.3450
Drummond, M., & Towse, A. (2019). Value-based pricing and reimbursement in personalised healthcare. Nature Reviews Clinical Oncology, 16, 65–66. https://doi.org/10.1038/s41571-018-0121-2
Garrison, L. P., & Towse, A. (2017). Managed entry agreements: Risk-sharing for innovative therapies. PharmacoEconomics, 35, 643–647. https://doi.org/10.1007/s40273-017-0526-4
Glassman, A. (2022). Financing global health in middle-income countries. World Development, 150, 105723. https://doi.org/10.1016/j.worlddev.2021.105723
Hitt, M. A., Ireland, R. D., & Hoskisson, R. E. (2011). Strategic Management: Competitiveness and Globalization: Concepts (9th ed.). South-Western Cengage Learning.
Iunes, R. F., Villar Uribe, M., Bonilla Torres, J., Garcia, M. M., Dias, C. Z., Alvares-Teodoro, J., Acurcio, F. A., & Guerra-Junior, A. A. (2019). Confidentiality agreements: A challenge in market regulation. International Journal for Equity in Health, 18(11), 1–6. https://doi.org/10.1186/s12939-019-0916-3
Javadinasab, H., Masoudi Asl, I., Vosoogh?Moghaddam, A., & Najafi, B. (2020). Comparing selected countries using sin tax policy in sustainable health financing. International Journal of Health Planning and Management, 35(1), 68–78. https://doi.org/10.1002/hpm.2817
Lomas, J. (2021). Outcome-based contracting in pharmaceuticals. Value in Health, 24, 1540–1547. https://doi.org/10.1016/j.jval.2021.04.012
McGuire, T. (2018). Demand for health insurance and risk adjustment. Journal of Health Economics, 60, 1–12. https://doi.org/10.1016/j.jhealeco.2018.01.002
OECD. (2018). Pharmaceutical pricing policies in a global market. OECD Health Working Papers, 63, 1–42.
Robinson, J. C. (2019). Pricing and coverage for pharmaceuticals in emerging markets. Health Affairs, 38, 1318–1325. https://doi.org/10.1377/hlthaff.2019.00314
Singh, P., Tracey, P., Dembek, K., & Leslie, P. (2025). The hidden cost of rushing into emerging markets. Retrieved from https://hbr.org/2025/09/the-hidden-cost-of-rushing-into-emerging-markets
Vlaanderen, F. P., Tanke, M. A., Bloem, B. R., Faber, M. J., Eijkenaar, F., Schut, F. T., & Jeurissen, P. P. T. (2019). Design and effects of outcome-based payment models in healthcare: A systematic review. European Journal of Health Economics, 20(2), 217–232. https://doi.org/10.1007/s10198-018-0989-8
Vogler, S. (2020). Access to medicines in emerging markets. The Lancet Global Health, 8, e1110–e1112. https://doi.org/10.1016/S2214-109X(20)30245-1
