Above is a representation of our Ability and Willingness to Pay analysis. In Country A, the patient’s ability to pay was the primary obstacle to product uptake, while in Country B it was the doctor’s low willingness to prescribe.

Affordability and Willingness to Pay Study

A comprehensive approach to understand barriers to treatment access in 8 markets in Asia and the Middle East


Unlike patients in established markets where medications are reimbursed, patients in emerging markets often bear the full cost of treatment. Thus, it is commonly assumed that cost is the major barrier to product uptake. However, ability to pay is not the only factor affecting pharmaceutical sales: the patient’s willingness to pay coupled with the doctor’s willingness to prescribe are key elements that affect product uptake.

In order to design an effective strategy to increase market share in out-of-pocket markets, it is necessary to gain local-level insights from both doctors and patients.


A large pharmaceutical company observed that its product was not selling at the level expected in several key emerging markets. To ascertain why this was occurring, the company enlisted Axios to investigate purchase decisions, identify barriers to treatment access, and formulate country-specific recommendations to increase product uptake in 8 markets in Asia and the Middle East.

Axios set out to investigate three key indicators affecting purchase decisions: the patient’s ability to pay, the patient’s willingness to pay, and the physician’s willingness to prescribe.

In the first phase of the study, Axios measured the ability of the entire population in each country to afford the medication at various cost levels.

To measure willingness to pay and prescribe, Axios conducted interviews with patients, doctors and pharmacists in each of the eight countries. The interviews assessed a myriad of factors including disease awareness, diagnosis, health facility access, prescription and medication purchase.

Specifically, the interviews examined the following: how willing would the physician be to prescribe the medication, and how willing would the patient be to purchase the medication, if it were less expensive? This willingness to pay and prescribe at different cost levels was plotted alongside patient affordability, revealing the impediments to product uptake in each country.

In the final analysis, revenue potential was captured in each country, highlighting the main barriers to access and providing recommendations for increased market share.


Findings from the study point to the importance of considering local-level decision makers, and not just high-level institutional stakeholders, when working in emerging markets. In the absence of government reimbursement, it is patients and doctors who are at the forefront of purchase decisions. Therefore, nuanced approaches to market research – particularly those that consider both affordability and willingness – are necessary.

This unique approach led to a more comprehensive understanding of the underlying factors affecting product uptake – paving the way for a successful strategy to increase market share.