Reimbursement Challenges and Opportunities in the MENA Region: A Comprehensive Guide

The MENA region presents a unique blend of opportunities and challenges in Pharma reimbursement, having made significant achievements in their healthcare systems over the last few decades, but also having to struggle with a lack of regulation and an absence of payment mechanisms in the current day. Healthcare spending and reimbursement are a strong point of contention in the US, and there are just as many different and complex factors that influence health expenditure in the Middle East and North Africa, and Pharma companies can play a big role.

The Reimbursement Landscape in MENA

Multiple Unregulated Systems: The MENA region suffers from low coordination, regulation, and planning of its healthcare systems, which is worsened by how massive the region is and how many different systems exist. Health status varies between countries in the region, and even within countries there are unequal distributions of resources, little planning of policies, and unequal access to care in general. This leaves large parts of each population without health coverage, and the populations that do have it contend with procurement and resource distribution issues on a regular basis. Most importantly, the region is a victim of increased demands for treatment due to preexisting malnutrition and the spread of noncommunicable diseases (NCDs) that exacerbate the socio-political and economic issues these countries are already dealing with. [1]

Out-of-Pocket Spending: In 2014, public spending for healthcare vs total spending in MENA countries such as Egypt, Morocco, Tunisia and Yemen were some of the lowest percentages compared to other countries in the world, inversely making out-of-pocket expenses high. Political instability and fluctuations in other essential resources such as oil and gas worsened the expenses for these populations, forcing many people to choose between adequate healthcare with little to nothing left, or paying for these important resources and not receiving proper treatments. In the years since, health expenditure as a share of GDP has increased but has still remained a small share of these countries’ economies, and the expenditure was less than the average of other countries with similar incomes. [1]

Private Health Sector’s Involvement: Rather than taking a preventative approach to keep the population healthy, many MENA countries adopt a curative approach to treat patients who are already sick, leading to higher healthcare costs [1]. Many of these services are funded by the private health sector, providing drugs and resources to areas that the public governments can’t provide. While the private sector can provide much-needed support by increasing efficiency, making resources more accessible and decreasing the total workload for these areas, they suffer from weak governance of their policies and regulations due to its fragmentation and the lack of consistent data regarding each of its providers. Governments of these countries have tried to integrate the private sector into their national health policies, but they lack any administrative framework to regulate their implementation and governments that have built private registries into their infrastructure rarely keep them up to date. Full collaboration between the public and private sectors is impeded by a lack of transparency between the two groups; the private sector sees the government as outdated and bureaucratic, while the governments dislike the private sector’s priority on making profits and see them as uncooperative. [2]

Overall, the MENA region heavily relies on the private health sector to make up for the low government spending on healthcare, which itself is influenced by political and financial instability and the spread of non-communicable diseases and malnutrition across these populations. Though it has improved some of these health systems, the private sector still operates on curative approaches instead of preventative ones which keeps treatment costs higher. Attempts to implement national policies or address the pharmacoeconomic issues are constantly at odds with the region’s inability to maintain timely data regarding population health, health spending between the public and private sectors, and standards of living to determine levels of poverty and the need to increase healthcare accessibility. Prepayments for health expenditure via taxes and insurance companies have increased but a majority of the region still has no coverage, and uneven distribution of their health resources aggravates this problem because more money is being spent for equipment and treatments than is necessary for so many patients. [2]

What can Pharma do?

Pharma companies can take a unique position between public and private sectors, able to act as a middle-man in partnerships with these groups to implement new methods of data collection and analyze that data for use in reforming regulatory and economic policies, as well as filling in gaps of information. One Pharma company, IQVIA, started using data collected about healthcare workers in the MENA region to create HCP Space, a networking platform that helps healthcare providers contact each other and manage patient information for diagnoses, interventions, and monitoring. [5]

Pharma companies can also implement access programs so countries in this region have better cost-effective access to treatments and medications and so they have the resources to develop new treatments and grant the MENA region direct access.

An example of these partnerships is with Glenmark Pharmaceuticals, whose subsidiary GSSA entered into a licensing agreement with Jiangsu Alphamab Pharmaceuticals and 3D Medicines in January 2024. The licensors agreed to supply GSSA with their new cancer treatment Envafolimab for development and commercialization exclusively in specific regions, including the MENA region. This partnership gives GSSA the resources to further develop this new treatment while ensuring that it’s commercialized in the MENA region once it has market access. [4]

Another example is a Pharma company named HK inno.N based in Korea. In April 2024, this company partnered with Tabuk Pharmaceuticals, a Saudi Arabian pharmaceutical firm, to export their GERD product K-CAB (tegoprazan) tablets, granting the MENA region accessibility to this drug which was only available in other parts of the world. [4]

Pharma companies have experience with these types of issues, especially those with global market access. They are prepared to interpret the data, provide solutions and accept new collaborations that can enhance the accessibility of their products and help with new drug developments. Companies like Sanofi, Novartis, and Pfizer have been in the MENA region for years and are continuing their work to expand their market access. [5]

Conclusion

Through regional partnerships and access programs, Pharma companies can directly provide support to MENA countries and help them overcome some of the healthcare challenges they’ve been facing for decades. Pharma companies can provide the most recent data and great networking capabilities that have prevented the MENA region from reforming, as well as an avenue for providing more accessible treatment methods for these populations. Economic data aggregated by these companies can be analyzed for considerations in price changes and reimbursement claims. A tool such as ReimbursementAI can take in newer health expenditure data and create a reimbursement model for specific countries in the MENA region, allowing the public-private partnerships to predict changes in pricing based on changing economic factors and account for those factors when providing medication and equipment. This could be extremely useful in countries that suffer from political and financial instability and even countries in conflict. [6]

References:

1. Katoue, Maram Gamal et al. “Healthcare system development in the Middle East and North Africa region: Challenges, endeavors and prospective opportunities.” Frontiers in public health vol. 10 1045739. 22 Dec. 2022, doi:10.3389/fpubh.2022.1045739 https://pmc.ncbi.nlm.nih.gov/articles/PMC9815436/

2. Health Finance & Governance Project. Health Trends in the Middle East and North America. July 2018. https://www.hfgproject.org/health-trends-in-the-middle-east-and-north-africa/

3. Alami, Randa. “Health Policies in MENA After Covid: Accelerating Reforms, Spearheading Health Equity.” ERF Policy Brief No. 70. Dec. https://erf.org.eg/app/uploads/2021/12/1639933511_936_346900_pb70_randaalami.pdf

4. TechSciResearch. Middle East & Africa Pharmaceuticals Market Size and Forecast| 2029. Accessed Jan. 27, 2025. https://www.techsciresearch.com/report/middle-east-and-africa-pharmaceuticals-market/15042.html#tab2

5. IQVIA. Middle East & Africa Pharmaceutical Market Insights, Thirteenth Edition. Jun. 2019. https://www.iqvia.com/-/media/iqvia/pdfs/mea/edition-13-mea-pharmaceutical-market-quarterly-report.pdf#:~:text=*%20Sanofi%2C%20Novartis%20and%20Pfizer%20are%20the,Novorapid%20(insulin%20aspart)%20and%20Novomix%20(insulin%20aspart)

6. ACMA Life Sciences. Field Reimbursement & Prior Auth AI. Accessed Jan. 16, 2025. https://acmalifesciences.org/acma-ai/reimbursement-ai