Translating Evidence into Action: An Implementation Outcome of the Medicaid PACE Access Program in Nigeria, 2023-2024
Background
Background: Nigeria faces vast inequities in accessing evidence-based breast cancer therapies. Although targeted treatments are clinically effective, uptake is limited by inadequate funding, fragmented diagnostics, and prohibitive costs. The Patient Access to Care Excellence (PACE) program, initiated by the Medicaid Cancer Foundation, is a civil society-pharma partnership designed to bridge this gap and expand affordable access to care in resource-limited settings.
Objectives: To assess the two-year implementation outcome of the PACE program, focusing on treatment access, utilization, financial protection, and barriers to care initiation using data from the foundation as a case study.
Methods PACE partnered with pharmaceutical manufacturers (Roche, Pfizer, Sanofi, AstraZeneca, and Janssen) to provide subsidized integrated cancer services across three components:
Treatment Access Solutions: providing subsidized targeted therapies (e.g., trastuzumab, pertuzumab, capecitabine, Trastuzumab Emtansine, Pertuzumab-Trastuzumab,bevacizumab).
Diagnostics Access Solutions: This covers biopsies, immunohistochemistry, and tumor markers.
Radiology/Radiotherapy: This services include CT scans, MRIs, and mammography, with radiotherapy added in 2024.The implementation outcome evaluated included enrollment, utilization rates, medication volumes, treatment continuation, monetary assistance and barriers to care.
 
Results
Data from 2023–2024 revealed significant growth and shifting clinical patterns:
Enrollment and Utilization: Patient enrollment grew by 53% (19 to 29 patients). While active patients increased from 14 to 20, the utilization rate saw a slight relative decrease from 74% to 69%.
Medication Distribution & Cost: Vials distributed rose by 82%, while total expenditures surged from ?25.8 million to ?62.1 million. This cost increase was driven by severe currency devaluation, with the exchange rate shifting from ?450/$1 in 2023 to ?1,545/$1 by late 2024.
Prescribing Patterns: In 2023, Trastuzumab and Trastuzumab Emtansine were primary. By 2024, the Pertuzumab-Trastuzumab combination and Bevacizumab (55 vials) dominated prescriptions.
Financial Protection & Prevention: In 2024, ?4.09 million in monetary assistance supported eight patients, covering 6% of medication costs. Despite this, care initiation challenges rose from 26% to 31%. Additionally, the program delivered 447 HPV vaccinations in 2023, expanding its scope toward cancer prevention. 
 
 
 
Key Outcomes
Access & Scale: Enrollment increased by 53% and medication distribution by 82%.
Service Expansion: Integration of radiotherapy and prevention (HPV vaccines) improved program completeness.Lessons
·  Collaborations between civil societes and the pharmaceutical industries serve as vital mechanisms for overcoming barriers to healthcare delivery in underserved regions.
·   While medication subsidies successfully lowered point-of-care prices, they remained insufficient against the broader financial volatility caused by naira devaluation and exchange rate fluctuations.
 
Conclusion: This implementation experience demonstrates that civil society-pharma partnerships can operationalize access to advanced cancer therapies in low-resource contexts. While stable utilization and expanding enrollment indicate program feasibility, persistent initiation barriers highlight the need for strengthened patient navigation and financial counseling. The PACE model offers actionable lessons for national cancer control efforts in low- and middle-income countries, emphasizing that multi-sectoral collaboration, integrated delivery, and adaptive financing are essential for advancing equitable cancer care.
 

Figure showing enrollment, utilization of medications for cancer treatment