Balancing Affordability with Willingness to Pay & Prescribe

Targeted strategy development for more sustainable access program design


Prostate cancer is the leading cause of cancer deaths among men in both Ghana and Nigeria.  A major pharmaceutical company working in both countries developed a drug to better treat patients with the disease, but the company noticed many doctors were not willing to prescribe the potentially living-saving medicine, and many patients were either unwilling or unable to pay for it.


Axios undertook a robust business case and access strategy development process focused on: 1)  identifying reasons for limited willingness to pay and prescribe the medications of interest 2) better understanding patient affordability in both countries 3) developing a targeted, sustainable access strategy and access program design targeted to the willingness and affordability insights gathered.

Willingness to Pay and Prescribe Study

Using a qualitative and quantitative questionnaire specifically designed for emerging market settings, Axios conducted interviews with local patients and physicians to understand potential barriers to prescription and purchase. In addition, the interviews were used to better understand the patient journey, test the product value proposition and to gather feedback on preferred Patient Support Program (PSP) designs.

Affordability and Economic Modeling

Axios’ validated affordability model was used to measure how many patients are able to pay for treatment at different cost levels. Inputs from the affordability model, market share and sales targets were then used to calculate incremental revenues and expected patient reach for various access scenarios as part of Axios’ economic modeling process. Together, the affordability and economic model were used to assess the economic value and expected sustainability of  different access scenarios.  Benefits and risks of each scenario were also identified.

Using the data gathered from the willingness study, and plotting the values against patient affordability, gave a holistic view of the preferred price point for both stakeholders. Axios then developed an access strategy targeted to the specific needs of the patient, product and country. A more targeted strategy development approach is key to ensuring a more sustainable and effective access program design.


Axios uncovered several findings that supported the development of a more sustainable access strategy for a critical access medication in Nigeria and Ghana, including:

Addressing patient affordability. A combined income-tiered and commercial scheme would result in the most financially sustainable scenario for patients and the company, while maintaining competitive advantage

Need for holistic program. A patient’s willingness to pay was not always linked to their ability to pay. The program needed to address both financial and non-financial barriers, such as disease and treatment awareness, emotional support and transportation gaps

Sustainability message was key. While doctors were aware of the product’s effectiveness, they were often unwilling to recommend treatment to their patients if they don’t believe their patients will continue the treatment plan until its conclusion. This made it important to emphasize the fact that the program would be designed to support patients for the full length of their treatment course.