1. The ATM Index – International Organizations Perspective Andreas Seiter The World Bank ICIUM 2011, Antalya 1

2. The World Bank and its clients Slide 2 Low-Income Countries Middle-Income Countries Financing (IDA, subsidized) Financing (market rates) Research, analytics, policy advice Overall goal: reduce poverty, increase equity

3. Interactions with industry IFPMA Fellowship Open door for policy dialogue with associations and individual companies No preference or discrimination in dialogue No engagement on procurement related issues (which would bar manufacturers from bidding) Slide 3

4. ATM Index A tool that serves a specific purpose – positioning companies in the global CSR debate Increases transparency, informs discussion on CSR issues Spotlight is on the top 10: more openness invites more scrutiny - the price of leadership? Slide 4

5. Digging deeper – testing the limits Slide 5 New treatment for pancreatic cancer: 1 year life extension for US$ 30,000 Ethical dilemma for payer – where to take the money from? Ethical dilemma for manufacturer – let those who can’t pay die early?

6. Policy tools: winners and losers Slide 6 Market segmentation and differential pricing Risk-sharing, “managed entry” Voluntary licensing Comprehensive patient access programs Long term donations Ad-hoc donations External reference pricing Compulsory licensing Narrow patient access programs Effective generic drug policies with fast uptake of low cost generics Rigid HTA for selection and value-based pricing Delayed registration of new drugs Prohibitive co-payments Indiscriminate administrative price cuts Arbitrary rationing Improved access & public benefit Higher cost to industry Italics: strategies based on industry initiative or partnership