Global Burden Of Unaffordable Or Inaccessible Health Care

  • 4.6 Billion Lack Essential Health Services – Confirms persistent global access gaps and validates a system-level affordability strategy.
  • 2.1 Billion Experience Financial Hardship – Highlights affordability, not only availability, as a core policy problem.
  • 1.6 Billion Are Pushed Into Deeper Poverty Due To Costs – Shows why medicine cost is central to financial protection.
  • U.S. Retail Pharmaceutical spending per capita, 2023 $1,713 – Demostrates that high-income countries also face exceptional affordability pressure.
  • U.S. Adults reporting any cost-related medication non-adherence in past year is 43% – Makes the case that a U.S.-orientated donor can view this as a domestic equity issue too.

ACCESS

  • The U.S. medicine affordability problems persist even when insurance coverage exists. Patients can be covered but under-protected because of deductibles, coinsurance, formulary exclusions, utilization management, specialty pharmacy routing, and the simple fact that high launch prices create downstream financial pressure throughout the system.
  • These pressures affect households directly and also distort employer benefit design, state Medicaid budgets, hospital uncompensated care, and the fiscal position of Medicare.
  • Current data demonstrate the persistence of these pressures. OECD reports U.S. per-capita retail pharmaceutical spending at more than twice the OECD average in 2023. RAND’s cross-country comparison finds that U.S. prices remain well above peer-country prices, especially for brand-name originators.
  • KFF’s 2026 polling shows the lived consequences: 43% of adults report some form of cost-related nonadherence, 27% report not filling a prescription because of cost, and 19% report cutting pills or skipping doses.
  • That pattern means affordability is no longer adequately measured by aggregate spending alone; it must also be measured by forgone care, treatment interruption, and adherence failure.
  • Recent federal reforms matter but do not eliminate the problem. CMS has implemented a $2,000 annual cap on covered Medicare Part D out-of-pocket costs beginning in 2025, and negotiated prices for the first cohort of Medicare drugs take effect in 2026. Those are meaningful steps. Yet even the success of those reforms reveals the depth of the underlying challenge: such interventions are necessary precisely because preexisting prices and benefit structures imposed unsustainable costs on beneficiaries. Moreover, the Part D cap does not solve affordability for people facing Part B drug costs, commercial deductibles, uninsured exposure, or coverage denials for products outside plan formularies.
  • Access4One’s relevance to the United States lies in its upstream orientation. A domestic affordability strategy cannot rely only on coupon support or downstream patient assistance. Those tools are administratively burdensome and often poorly targeted. A more durable domestic strategy reduces the cost base before launch, shortens development timelines that consume capital, uses smarter portfolio design to avoid waste, and builds channel partnerships that favor access-oriented placement and procurement.
  • Access4One therefore complements policy reform rather than competing with it. It can produce practical, funder-visible interventions that sit between science and policy: better development economics, better contractual design, and better translation of efficiency into patient affordability.

When Access4One demonstrates methods that can reduce the affordability burden for American patients and health systems, those methods become more credible to international partners.

U.S. and International donors, in turn, can support a platform that improves domestic health equity while building a globally relevant template for affordability-oriented biopharmaceutical innovation.

JOIN US IN BRINGING HEALTH CARE AND KEY MEDICINES TO MILLIONS OF PATIENTS IN NEED

A4ONE is launching and scaling the platform, with opportunities for partners/donors to participate in creating commercially affordable sustainable solutions that have long term impact, for access to medicines.