Health equity can be a competitive advantage: What pharma leaders need to know

As NICE begins to incorporate health equity into drug reimbursement decisions, forward-looking pharmaceutical companies have a chance to lead – aligning innovation with access drivers and gaining a competitive edge in a changing global landscape.

A new perspective in drug reimbursement

A shift is underway in how the value of drugs is measured, and it’s starting in the UK. The National Institute for Health and Care Excellence (NICE) has begun weaving health equity into its reimbursement decisions. In some cases, that means recommending reimbursement for treatments that don’t meet traditional cost-effectiveness thresholds. Instead, NICE is considering other measurements of value to make their recommendations. This shift could have significant implications for pharmaceutical companies who are bringing new therapies to market.

Health equity, long discussed in theory, is now becoming a practical consideration in HTA decisions. But evaluating its impact is not easy. It requires robust data to assess outcomes across population subgroups, along with new modelling approaches that reflect real-world barriers to care. As academic and industry efforts mature, these tools are becoming more feasible and, in some cases, will be expected. NICE is not merely talking about health equity; it is operationalising it. That change isn’t broadcast in headlines, but it’s there in the HTA agencies’ documentation – quietly shaping reimbursement outcomes. And while the methodology is still evolving, the direction is clear: value assessments are broadening to include who benefits, not just how much.

For pharma, this represents more than a policy shift. It’s an inflection point. Companies that integrate equity considerations early will not only be better prepared for changing payer expectations, they’ll be better positioned to lead the market in expanding access to therapies, improve patient outcomes, and secure reimbursement.

The old rules are changing: Health equity’s role in HTA decisions

Historically, health technology assessment (HTA) bodies such as NICE and Canada’s Drug Agency, CADTH, have prioritised cost-effectiveness in their evaluations. Cost-effectiveness provides a common currency for comparing different types of interventions. It aims to quantify the value of health outcomes relative to the cost of the intervention, supporting a more fair allocation of therapies. However, this model can overlook differences in access, uptake, and outcomes across diverse population groups. A drug that performs well overall may still exacerbate disparities if it systematically underdelivers in underserved communities.

Health equity introduces a new dimension to this evaluation framework. Rather than assessing average outcomes alone, HTA agencies are beginning to ask: who benefits from this treatment? Are there structural or systemic factors that could limit its reach? Could broader access to this therapy help close gaps in care for disadvantaged populations?

NICE is among the first major HTA bodies to meaningfully address these questions. It has begun to incorporate health equity as a value modifier – recognising that, in some circumstances, the social value of a treatment extends beyond clinical trial endpoints or traditional cost-effectiveness.

Examples of data increasingly relevant to HTA submissions include:

●Patient demographic data: Incorporating race, ethnicity, income level, geography, and education status helps assess which populations are affected by the condition and how.

●Clinical trial diversity: Ensuring study populations reflect real-world demographics improves generalisability and can identify subgroup-level efficacy and safety.

●Stratified health outcomes: Disaggregating trial or real-world data reveals how various pre-specified subgroups respond to treatment, highlighting potential inequities in outcomes.

●Social determinants of health (SDOH): Data on housing, nutrition, transport, and healthcare access provide context for how likely a population is to benefit from a treatment.

●Equity-focused economic models: New tools like distributional cost-effectiveness analysis (DCEA) can weigh the impact of a drug on population-level disparities, not just on average gains. NICE’s proposed update to its technology evaluations manual specifies that, when health equity impact is expected to be substantial, health inequity analyses should be presented in the form of DCEA, supplementary to the main cost-effectiveness analysis.

●Utilisation and access barriers: Evidence around where patients are falling through the cracks – including insurance coverage, provider availability, and logistical hurdles – can signal broader access limitations.

These data points aren’t just scientifically informative; they are becoming accepted components of a compelling reimbursement case. And while no HTA agency has yet mandated health equity modelling, the shift in expectations is clear.

Pharma’s next move: Turning equity into an advantage

For pharmaceutical companies, the rise of health equity in reimbursement discussions is a call to action. While HTA bodies aren’t yet prescribing exactly how equity should be incorporated into value assessments, those who do have reaped benefits.

Companies that proactively address equity can strengthen their submissions, stand out in crowded markets, and future-proof their strategies.

Here are three core actions to consider:

1.Quantify the equity impact: New modelling approaches like DCEA can help quantify how a treatment affects health disparities. Unlike traditional cost-effectiveness analysis, DCEA considers not just the overall efficiency of a treatment, but also its impact on fairness. For example, does the intervention help a historically underserved population catch up in terms of health outcomes? This kind of modelling is still in its early days, but shows real promise. Starting now, even with exploratory analyses, allows companies to refine their approach and build internal capabilities over time.

2.Unite cross-functional teams: Equity is not solely an access issue – it touches clinical trial design, real-world evidence, medical affairs, patient advocacy, and corporate responsibility. Yet, in many companies, health equity teams operate separately from commercial and access functions. By creating integrated working groups, companies can ensure that their scientific and social impact efforts inform payer-facing narratives. This alignment not only leads to more coherent submissions, but also improves internal ROI on health equity investments.

3.Make the most of what you’re already doing: Many companies have invested in trial diversity, community engagement, and patient support programmes. These efforts are inherently valuable and can be used to support reimbursement recommendations. For example, a treatment that can be administered outside a specialist centre may be recommended because its availability and accessibility may improve access in rural areas, or drugs that are easier to ship or store may be recommended because they are more readily available to patients with limited mobility or access to transportation.

Connecting these dots for HTA bodies is not about marketing spin – it’s about demonstrating relevance, value, and foresight in addressing societal needs.

A case study in change: NICE’s 2024 decisions

A recent review of NICE’s 2024 decisions shows multiple examples where health equity explicitly factored into the agency’s recommendations. In some cases, drugs were approved despite not meeting conventional cost-effectiveness thresholds. The rationale? Their potential to reduce health disparities or serve populations with limited alternatives.

Casgevy for beta thalassemia is one such example. The treatment targets a rare condition that disproportionately affects individuals from Bangladeshi, Indian, and Pakistani communities in the UK. NICE acknowledged this equity dimension in accepting a higher cost-effectiveness threshold than would normally apply. Another example is with Vyalev for Parkinson’s disease, where the equity benefit derived not from the disease profile, but from the treatment modality. Unlike alternatives that require administration in specialist centres, Vyalev can be delivered in more accessible settings – removing logistical barriers for patients in remote or underserved areas.

These decisions signal a recalibration of how value is assessed. Traditional cost-effectiveness remains central, but equity is increasingly recognised as an additional value driver. NICE’s approach provides a framework for a more nuanced, patient-centred strategy that other HTAs may soon emulate.

What’s next: Preparing for future opportunities

As HTA bodies evolve, so must the pharmaceutical industry. The environment is not yet prescriptive about how to measure or present health equity impacts, which gives companies a window to innovate – and lead.

For those companies who want to be ahead of this evolution, there are key areas to begin investing in:

●Start early: Integrate health equity questions into target product profiles, trial protocols, and evidence generation plans. If equity relevance is discovered late, it may be too late to gather the right data.

●Invest in modelling tools: Develop internal or partner capabilities in DCEA or similar frameworks. Even a model using imperfect data or assumptions can show commitment and establish a foundation for refinement.

●Educate internally: Equip commercial, medical, and R&D teams with a shared language and understanding of how equity influences access decisions. This internal fluency can enhance cross-functional collaboration and strategic planning.

●Plan for global variation: Each market will integrate equity at a different pace and with different criteria. Companies must monitor developments across geographies and tailor their submissions accordingly.

The bottom line: Aligning equity with access and impact

Equity won’t apply to every drug or indication. But the expectation is that it should be considered every time, and leaned into when relevant. This shift requires a mindset change: equity is not just a differentiator; it’s a responsibility.

Ultimately, integrating health equity into payer communication is about more than checking a box. It’s about telling a richer, more relevant story – one that resonates with HTA decision makers, reflects public health priorities, and expands the reach of life-changing treatments. The companies that succeed in this new environment will be those that bridge innovation and impact, delivering therapies not just to those who can access them easily, but to all who stand to benefit. In doing so, they’ll help define the next generation of value in healthcare – and reshape what it means to lead.

About the author

Mary Fletcher-Louis is managing director and head of the Value Center of Excellence at Trinity Life Sciences. She brings over 25 years of healthcare and consulting experience to Trinity. She has extensive experience in value strategy and in the development of value communication tools spanning diverse therapy areas. Fletcher-Louis has deep experience of the decision drivers of market access stakeholders across multiple countries and stakeholder types. Fostering a culture of innovation in all her endeavours, she is currently pioneering the integration of health equity into life sciences value strategy. As a senior thought leader in the industry, Fletcher-Louis has held leadership roles in various domains including global market access, HEOR, market forecasting, and primary market research. For several years, she led DRG’s Value Communication Center of Excellence. Her academic achievements include a Master’s in Public Health from Nottingham University and a BA from Oxford University.