The world’s leading pharmaceutical companies are doing more to improve access to medicine in developing countries, with a raft of new initiatives, scale-ups and innovations over the last two years. However, the industry struggles to perform well in some practices that matter, according to the 2014 Access to Medicine Index, published by the Access to Medicine Foundation, a nonprofit organization based in the Netherlands that aims to advance access to medicine by encouraging the pharmaceutical industry to play a greater role in improving access to medicine in less developed countries.

GSK tops the Index for the fourth time, driven by robust performance across most areas and several innovative practices. Novo Nordisk has made the most progress, improving in five of the seven areas the Index focuses on. This has resulted in a remarkable leap from 6th to 2nd place. Astellas, Daiichi Sankyo and Takeda remain at the bottom of the league.

“Companies that have the biggest market presence are not necessarily at the top of the Index. We found that four companies currently produce 50% of all the relevant products. However, they are scattered across the Index,” said Jayasree K. Iyer, head of research at the Access to Medicine Index. “This means that what defines where companies rank has less to do with how many relevant products they have, than with what they do with their products and expertise.”

The industry has stepped up its efforts on several fronts. For instance, it is paying more attention to socioeconomic factors, increasingly tailoring prices within countries. Since 2012, the number of products in the pipeline appropriate for developing countries has grown by 47. More companies are experimenting with innovative access-oriented business models. Companies are granting more licenses to developing country companies to make and distribute generic versions of their medicines. Meanwhile, policies and activities to improve access to medicine continue to get better organized.

However, progress is uneven across the areas of activity that matter, with the industry struggling to perform well in two important areas.

Firstly, nearly all companies (18) have been the subject of settlements or judgments regarding breaches in ethical marketing, bribery or corruption standards or competition laws in the last two years. During the period of analysis there were high-profile allegations of corrupt practices against several companies operating in China. The case against GSK, one of those companies, was settled after the period of analysis, and therefore did not affect its score in the 2014 Index.

Secondly, companies remain conservative in their disclosure of where patents are active and when they will expire—information that is very useful to medicine procurers and generics manufacturers.

Pharmaceutical company R&D is a crucial element of enhancing access to medicine. Just five companies are developing 54% of the 327 products in the pipeline. All disease classes are being targeted, but more than half of the products under development target just five diseases.

About 36% of the pipeline targets non-communicable diseases, which are becoming increasingly important in developing countries. But plans to make these products available in developing countries are limited. Pricing strategies for them also are limited, and lag behind those for many communicable diseases.

More than half of the companies are developing “child-size” medicines, as liquids, chewable tablets, child-appropriate doses or new formulations.

The Index methodology was developed, and is continually refined, in consultation with multiple stakeholders including the World Health Organization, NGOs, governments, universities and institutional investors. The Index is funded by the Bill & Melinda Gates Foundation, the Dutch Ministry of Foreign Affairs and the U.K. Department for International Development.