Key Takeaways
When Axios International began its work nearly three decades ago, affordability was one of the most visible barriers keeping patients from treatment. Years of research and experience have shown that access depends on far more: how patients and physicians perceive treatment value, local economic and healthcare conditions, treatment-specific barriers, and the realities of patients’ lives.
- What works in one market may not work in another.
- Some barriers extend beyond any program’s control.
Why Affordability Alone Never Guaranteed Access
When Axios began its work in patient access, one of the most visible barriers was straightforward: patients could not afford their treatment.
Affordability remains a critical part of access. But years of working with patients, physicians, pharmaceutical companies, healthcare providers, and other stakeholders have shown that the relationship between treatment and access is much more complex.
A patient can have a prescription and still not receive treatment. They can qualify for financial support and still choose not to begin therapy. A physician can have access to a treatment and still decide not to prescribe it. And a program that works well in one country can produce very different results in another.
These experiences changed how we think about access.
The patient journey extends from diagnosis and treatment initiation through adherence and long-term management. At every stage, different factors can influence whether a patient reaches treatment, starts it, and remains on it. Financial circumstances matter, but so do treatment perceptions, physician decision-making, healthcare infrastructure, cultural context, and the practical realities of living with a disease.
Some of these lessons emerged when programs did not produce the outcomes we expected.
In some cases, generous financial support was available, yet physicians were not referring patients or patients were declining treatment. The financial barrier had been addressed, but another barrier remained.
This led us to examine a broader question: what determines whether a treatment is considered worth accessing in the first place?
Multi-country research with patients and physicians examining willingness to pay and willingness to prescribe provided part of the answer. When different price points were presented to physicians, researchers found that prescribing decisions were influenced by perceived treatment value as well as price. At certain price points, physicians were less likely to prescribe even when patients were willing or able to pay.
Research involving asthma treatment reinforced the importance of perceived value in treatment decisions. These findings demonstrated that understanding the perceived value of a treatment can be an important consideration when developing an access strategy.
The importance of context became even clearer when comparing markets.
A comparative analysis of asthma treatment in India and Egypt found meaningful differences in how patients and physicians responded to treatment prices. In India, patients were less willing to pay higher prices even when they had the financial ability to do so. In Egypt, higher treatment costs were associated with greater receptiveness among both patients and physicians.
The lesson was not that one market had the right response and the other did not. It was that economic conditions, perceptions, and healthcare decision-making are highly contextual.
An access strategy therefore needs to begin with an understanding of the specific patient population, treatment, healthcare environment, and market in which it will operate.
How Research Has Shaped the Way We Approach Access
Experience alone is not enough to understand complex access barriers. It needs to be paired with research, data, and continuous learning.
Financial assessment provides one example.
Axios’ Patient Financial Evaluation Tool (PFET) was developed to help assess a patient’s ability to contribute toward treatment costs. Since 2006, the tool has been refined and evaluated through real-world application and research, including studies published in peer-reviewed journals.
One study involving 1,404 patients across Thailand, the United Arab Emirates, and Mexico examined which factors were most important in accurately assessing ability to pay. By incorporating measures including income, assets, and standard of living, the research demonstrated how financial assessment could be adapted to different economic environments, including settings where informal economies play an important role. The findings also helped identify the factors that contributed most to the accuracy of the assessment and informed subsequent refinements.
Research into treatment adherence provided another important insight.
Patients enrolled in an access program remained on treatment for an average of 465 days, compared with 226 days among patients who did not participate in an access program. While adherence is influenced by many factors, the difference illustrates the potential role that structured access support can play in helping patients remain on treatment.
Research has also shown why access strategies need to consider the details of how care is delivered.
For example, studies examining pharmacy-based treatment support have produced different findings depending on the disease area. Research into COPD treatment in Egypt found that patients served by smaller pharmacies experienced better outcomes, potentially reflecting the benefits of closer pharmacist-patient interaction. Research examining oncology treatment in Lebanon found the opposite pattern, with larger pharmacies associated with better adherence and fewer dropouts, potentially reflecting the specialized expertise and infrastructure required for complex oncology treatment.
Neither finding establishes a universal model.
Together, they demonstrate why access strategies need to account for the treatment, healthcare setting, patient population, and specific barriers involved. Evidence can help identify what is working, but it also needs to be interpreted in context.
That principle has shaped how we approach access over time: research should not simply validate a program after it has been designed. It should help inform how the program is designed in the first place.
What’s Beyond Any Program’s Control
Even the most carefully designed access strategy operates within a healthcare system and broader economic environment that it cannot fully control.
Economic instability, changes in healthcare financing, availability of healthcare professionals, infrastructure, and broader social conditions can all influence whether patients are able to access and remain on treatment.
Lebanon’s economic crisis illustrates the scale of that challenge. Research examining cancer care during the country’s economic downturn found significant changes in patient outcomes, highlighting how closely health outcomes can be connected to the stability of the wider healthcare and economic environment.
These forces cannot be solved by an individual patient access program. But they can be recognized, monitored, and incorporated into how access strategies are designed.
That distinction matters because sustainable access depends on understanding both what a program can influence and what it cannot.
Nearly three decades of work in patient access have reinforced a simple idea: there is no single barrier to access and, therefore, no single solution.
Financial support can address affordability. Assessment can help identify individual patient needs. Research can reveal how patients and physicians make decisions. Data can show where programs are succeeding and where they need to evolve. Local knowledge can help ensure that a strategy reflects the realities of a particular market.
These elements work together to create a more complete understanding of what it takes to move a patient from diagnosis to treatment and, ultimately, to sustained care.
The questions we ask about access have therefore become more specific over time. Instead of asking whether a patient can access treatment, we increasingly need to understand where the access journey is breaking down, why it is happening, and what evidence can help address it.
As healthcare systems, treatments, and patient needs continue to evolve, those questions will continue to shape the next generation of access strategies.
