IndexIntroductionBarriers to market accessPatients as payersConclusionIntroductionAs a result of the success of decades of public health investments and efforts that have reduced the burden of infectious diseases, chronic diseases are in the main health threat in emerging markets is increasing. Likewise, as GDP and well-being have increased in these markets, a side effect has been the increased prevalence of obesity, diabetes, cardiovascular disease, and diseases associated with aging such as cancer. In Latin America, for example, cancer has become the second leading cause of death, and cancer is now the leading cause of death in China. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay. However, healthcare infrastructure in emerging markets has not kept pace with this increase in cancer prevalence. Insufficient public funding, shortages of oncology specialists, inefficiencies and fragmentation of the healthcare system, inequalities such as urban-rural gaps in access to healthcare, and limited access to innovative drug therapies are just some of the challenges faced in these markets . Despite these challenges, emerging markets' growing need for cancer prevention, screening, early detection, diagnosis and treatments presents opportunities for pharmaceutical and biotechnology manufacturers in terms of both positive impact and revenue growth. Succeeding in these markets requires unique considerations and approaches, given the challenges faced by all stakeholders: patients, healthcare providers and payers. We briefly highlight these factors below. Barriers to market access For middle- and low-income countries, which generally have younger populations and shorter life expectancies, health priorities have historically focused on childhood and communicable diseases rather than chronic diseases or of the aging population. Also common to many of these countries is the existence of universal healthcare provided by the government, often at levels limited to basic healthcare needs and often insufficient. Private insurance may be rare or unavailable, and limited reimbursement by public health systems can lead to high out-of-pocket health care costs. Inequalities in health outcomes and large disparities in access are systemic problems in emerging markets. Given limited resources and public health budgets that have not grown despite epidemiological changes, public funding for costly diseases like cancer has been deprioritized, resulting in shortages of myriad resources, from public health awareness campaigns to trained personnel treatment facilities. Many cancer cases are diagnosed at advanced stages of the disease due to limited access to screening procedures, and for patients who are diagnosed and seek treatment, access to therapies can be difficult and cost-prohibitive, often leading to discontinuation of treatment. In Ecuador, for example, in 2014, 40% of families affected by pediatric cancer stopped treatment for financial reasons. Government health systems are cost-limited and have multiple mechanisms to deny or slow access to the most innovative but also most expensive drugs. Regulatory delays are rampant and drug approval processes are inefficient and often lead to rejections. China, for example, has only 345 registered employees in its drug regulatory agency, the China Food and Drug Administration(CFDA), compared to 9,300 employees at the US FDA. This invariably results in approval delays, with the review period for some new medicines taking 14 to 28 months to complete. Of the 49 new cancer treatments brought to market between 2010 and 2014, only six are available in China, compared to 41 in the United States. In addition to approval, inclusion in national drug lists represents an additional challenge that pharmaceutical companies face in some markets. Furthermore, the competitive landscape may be rich in generic and biosimilar drugs and the priority for approval or reimbursement is often given to local producers. There may be significant downward pressure on the pricing of innovative therapies in these markets, along with the expectation of greater price transparency and/or tiered pricing. For cost-containment reasons, some federal payers such as Brazil's Sistema Único de Saúde (SUS) and Mexico's Il Seguro Popular exclude from coverage high-cost, targeted cancer therapies, such as trastuzumab (Herceptin) for HER2-breast cancer. positive. Furthermore, even if approved in a market, access is not guaranteed. In Brazil, 25% of the privately insured population will have access to drugs upon approval, but for the rest of the population that depends on the public healthcare system, coverage of new drugs can be delayed by up to a decade. This stalemate tactic has led to frequent lawsuits from patients, with 3.3 percent of publicly insured cancer patients obtaining their drugs through SUS lawsuits between 2012 and 2014. Another example of a barrier to access that some patients, such as those in Belarus and Kazakhstan, face limited and insufficient supplies of some approved therapies. These governments purchase and reimburse only a certain amount of oncology drugs each year, and patients only have access to these treatments while supplies last. Patients as taxpayers Public health insurance in emerging markets is often limited to basic needs or may be limited to an annual limit – or annual volume, as in the case of Belarus and Kazakhstan – that is insufficient for cancer treatments . Because of these limitations, like these and others, the burden of covering the costs of cancer treatment falls largely on patients in emerging markets, whether in the form of purchasing private insurance or paying out-of-pocket for services and treatments . Due to the price sensitivity of patients and payers in these markets, unique approaches must be taken to maximize access to therapies. Promotions such as “buy In the Philippines, for example, where public health funding does not cover biologic drugs and 80% of the population pays for healthcare out of pocket, Roche has established a program to increase access to Herceptin for patients with HER2-positive breast cancer. A third party assesses the patient's ability to pay for the treatment and then price discounts are set based on their financial situation. This discount program has significantly increased treatment and adherence. Medical tourism is another mechanism exploited by some patients with the physical and financial means to travel. Patients may travel internationally to seek access to treatments or specialists not available in their home country or to higher quality medical care, while other medical tourists may travel to obtain comparable procedures or treatments at a fraction of the price they)..