In addition, more companies are using tiered pricing schemes to lower prices for certain countries or population groups within a country, and applying them to a broader range of products and in more countries.However, there are still several areas where all companies could improve their approaches significantly. These include being more transparent about their lobbying practices, expanding their tiered pricing schemes, adapting packaging to local needs, making their drug donations more needs-based, and allowing their clinical trial data to be used to accelerate the approval of generic medicines in developing countries. An area where current industry performance falls far short of Index expectations is transparency around the outsourcing of clinical trials to Contract Research Organisations (CROs). Companies often hire them to conduct clinical trials on their behalf in developing countries, but no company is publicly transparent about all the CROs they employ. Company accountability involves ensuring the wellbeing of trial participants through adequate due diligence in selecting these contractors, monitoring how they conduct the trials and willingness to enforce codes of conduct with disciplinary action. However, only four companies (Merck & Co., Sanofi, GlaxoSmithKline and Eisai) provided evidence that they use disciplinary measures to enforce codes of conduct with their CROs to ensure that trials of their products are conducted safely and ethically. "Access to medicine is a multi-faceted challenge and therefore responsibility for improving it lies with a number of different actors, but the pharmaceutical industry has a critical role to play. While the Index shows it has made strides in many areas, companies that have sector-leading practices also show us there is more the industry can contribute," Leereveld said. Notes: The Access to Medicine Index is published by the Access to Medicine Foundation, a non-profit organisation based in the Netherlands that aims to advance access to medicine in developing countries by encouraging the pharmaceutical industry to accept a greater role in improving access to medicine in less developed countries. The Index methodology was developed, and is continually refined, in consultation with multiple stakeholders including the WHO, NGOs, governments and universities, as well as 30 institutional investors. The Index is funded by the Bill & Melinda Gates Foundation, the Dutch Ministry of Foreign Affairs, the UK Department for International Development and other charitable organisations. The scoring and ranking of company performance for the 2012 Index was conducted by MSCI ESG Research, which provides environmental, social and governance ratings, screening, analysis, benchmarking and compliance tools to advisers, investment managers and asset owners worldwide.