It scores companies on their commitments, performance, innovation and level of transparency across seven areas of activity considered key to improving access to medicine. The companies are graded on more than 100 factors covering these areas, including whether they are developing new drugs for neglected diseases, to what extent they facilitate or resist efforts to create generic versions of their drugs, and how they approach pricing in developing countries. Lobbying activities, marketing ethics and product donations and other philanthropic activities are also tracked.Ranking highlights: Who is doing the most? GlaxoSmithKline remains at the top of the Index with a marginal improvement in performance since 2010, and this year, Johnson & Johnson and Sanofi, both new to the top three, follow closely in 2 nd and 3 rd positions respectively. The companies that rose in rank the most were Merck KGaA, followed by Johnson & Johnson, and then Bayer. AstraZeneca fell down the rankings most significantly, followed by Boehringer-Ingelheim, then Novartis and Roche. The bottom of the league is dominated by Japanese companies Takeda, Daiichi and Astellas. Overall trends Seventeen out of the 20 companies perform better than they did at the time of the last Index in 2010. At the top end, membership of the leading group has expanded from three to seven companies, and there is a smaller difference between the scores of the Index leaders than there was in 2010. Meanwhile, the gap has also narrowed between the bottom few companies and the top performers. This is notable given the fact that the Index set higher standards this year in many areas. Companies are developing more products for more diseases that particularly affect the world's poor, and collaborating more in the process than they were two years ago. There is more target setting and some now devote as much as 20% of their pipeline to developing products that address the needs of the poor. For instance, Sanofi is adapting its leishmaniasis drug, which currently requires health workers to administer repeated injections, to develop a product that patients can apply to their skin at home. Meanwhile, Johnson & Johnson is collaborating to develop a simple portable rapid screening test for tuberculosis that doesn't need to be operated by a health professional, requires patients to simply cough into a breathalyser, and yields results within minutes.