How Patients Afford Innovative Medications

How do patients afford innovative medication in emerging markets?

It’s the question every Market Access launching in a new market eventually asks — usually somewhere between regulatory approval and the first sales forecast, once “the medication will be on the shelf” runs into “but will anyone actually be able to pay for it?”

It’s not a cynical question.

It’s the honest one.

And in emerging markets, the honest answer is uncomfortable: for a large share of patients, out-of-pocket cash is still the primary way healthcare gets paid for — not insurance, not the state.

We looked at the numbers across the three regions where this question comes up most.

Southeast Asia: progress, but still a cash-pay reality

Across ASEAN markets, out-of-pocket spending averaged roughly 31% of total health expenditure in the most recent OECD data — well above the 19% average across OECD countries.

The regional picture is uneven: Brunei and Thailand sit near 8–9%, while other markets in the region remain far higher, and seven of eight countries studied did reduce their out-of-pocket share between 2012 and 2022, with Indonesia, Laos, and Singapore posting the largest gains.

Vietnam is a market worth a closer look on its own.

Pharmaceuticals account for an estimated 39% of current health expenditure there — a notably higher share than Malaysia (16%), Indonesia (21%), or Thailand (31%). In other words, medicines themselves are a disproportionate driver of what Vietnamese households pay out of pocket, which is precisely where a copayment or affordability program has the most leverage to change patient behavior.

Latin America: one-third of health spend, paid at the point of care

The Pan American Health Organization’s most recent regional financing review puts out-of-pocket spending at roughly one-third of current health expenditure across Latin America and the Caribbean — well above the under-20% threshold PAHO considers necessary for real financial protection.

The country-level spread is wide. Guatemala’s out-of-pocket share has been estimated near 61%, Honduras around 52%, while Cuba sits close to 8%.

For a pharma sponsor building a regional LatAm launch plan, that spread means the affordability strategy that works in Mexico City will not automatically work in Guatemala City — the financing architecture underneath the patient is simply different.

Africa: above WHO’s own recommended ceiling, region-wide

The WHO African Region’s own health expenditure atlas puts average out-of-pocket spending at 35.8% of current health expenditure over 2012–2020 — nearly double the 15–20% ceiling the WHO itself recommends to keep healthcare from becoming a source of financial hardship. Across the region, the spread runs from single digits to well over half of health spending in some countries, and household medicine costs are consistently one of the largest components of that out-of-pocket burden.

The pattern underneath the numbers

Three regions, three very different health systems, insurance markets, and regulatory environments — and the same structural fact: in every one of them, out-of-pocket spending sits meaningfully above the level global health bodies consider safe for patients. That’s not a footnote to a market entry plan. It’s the central design constraint.

This is also why “we’ll figure out affordability after launch” doesn’t hold up as a strategy. If a third or more of the health system’s total spend is coming directly out of a patient’s pocket, affordability isn’t a post-launch patient support add-on — it’s a go-to-market decision, on the same planning timeline as pricing, regulatory strategy, and distribution.

The Pharma Sponsor’s question, in other words, isn’t a side concern to raise with the patient support team once the product is approved.

It’s the question the entire commercial model in these markets has to be built around from day one.

Where this leaves the Market Access:

We’d argue the useful reframe isn’t “how do we help patients afford this after approval” — it’s “what does the affordability infrastructure in this specific market actually look like, and does our program design match it.”

A copay model built around Thailand’s payer mix won’t transplant cleanly into Guatemala’s, and a program designed for Vietnam’s pharmaceutical-heavy out-of-pocket burden needs different levers than one built for a market where hospitalization, not medicines, drives most of the cost.

That market-by-market precision — not a global template — is what separates access programs that move the needle from ones that exist mostly on paper.

So a program gets built. Then what?

Say the Pharma Sponsor’s question gets asked early, and gets answered: a patient access program gets designed and funded for the market. That’s the right call — but it’s also where a second, quieter problem tends to show up.

A patient gets diagnosed. The physician prescribes. And then — nothing happens for 30 days.

Not because the medicine isn’t available. Not because the patient doesn’t want it. Because somewhere between the prescription pad and the pharmacy counter, a paper-based means test, a manual eligibility review, and multiple approval sign-offs are quietly grinding through a queue.

We call this the 30-Day Problem, and in emerging Asia Pacific, it’s the default state of most access programs — not the exception.

The cost nobody puts on the slide deck

Every patient support program has a budget line for “reimbursement cycle time.” Almost none of them have a line for what that cycle time actually costs.

• Patient drop-off. A patient who waits three days for a decision stays engaged. A patient who waits thirty starts asking a different question: is this treatment even for me? Some don’t come back. That’s not a conversion problem — it’s a design problem.

• Sponsor budget leakage. Copayment and patient assistance funds sitting in a 30-day approval queue aren’t doing what they were funded to do. Slow disbursement doesn’t just delay impact, it distorts it — sponsors end up planning around cycle time instead of patient need.

• Operational friction at the hospital. Physicians and hospital staff didn’t sign up to be case workers for a manual eligibility process. Every extra form, every fax, every “please resubmit with updated documentation” chips away at the willingness of your best access partners — the hospitals themselves — to keep referring patients into the program.

None of this shows up as a single line item on a launch plan. It shows up as a program that technically exists but structurally underperforms — and a set of quarterly numbers that never quite explain why.

Why the delay exists in the first place

It’s not that anyone building these programs wants them to be slow. Most patient access infrastructure in the region was built for a different era — one where “digital” meant a PDF form instead of a paper form, not a real eligibility decision made in real time. Three structural issues repeat across almost every program we’ve reviewed:

1. Manual means testing — eligibility assessed by hand, against inconsistent documentation, on a timeline set by whoever’s desk the file lands on next.

2. Fragmented systems — the hospital, the sponsor, and the assessment body often aren’t looking at the same data, at the same time, in the same format.

3. No audit trail by design — compliance and finance teams end up reconstructing what happened after the fact, rather than having it captured as it happens.

Fix the first two, and the third — the thing regulators, auditors, and sponsor compliance teams actually care about — comes free.

This is the problem MED was built to solve

We started MED because this question — will patients actually be able to afford this, and will the program get out of its own way — kept getting asked after launch, when it should have been answered before it.

Across Vietnam, the Philippines, and Indonesia, we work with pharma sponsors to design and run patient access programs that are built around how each specific market actually finances healthcare, not a template copied from somewhere else.

That means digital means testing calibrated to local payer mix, transparent fund flow sponsors can audit, and eligibility decisions in days rather than weeks — so the affordability conversation happens at launch, not as damage control six months in.

If your team is asking the Market Access’s question for a market you’re entering or already in, we’d welcome the conversation. Get in touch with MED to talk through what an access program built for your specific market could look like.

Sources - OECD, Government at a Glance: Southeast Asia 2025 — out-of-pocket healthcare expenditure, Figure 6.5 - World Bank / World Health Organization Global Health Expenditure Database, Vietnam pharmaceutical expenditure report (2025) - PAHO/WHO, Financing of Health Systems in Latin America and the Caribbean: Main Trends as of 2023 - Statista/WHO, out-of-pocket share of health expenditure by LAC country (2021 data) - WHO Regional Office for Africa, African Region Health Expenditure Atlas 2023