For the fourth time, GlaxoSmithKline has led all other pharmaceutical companies on an influential list ranking companies by how effectively they help the world’s poor get needed medicines.

The list, the Access to Medicine Index, has been published every other year since 2008 by a group in the Netherlands financed by the Bill & Melinda Gates Foundation and the British and Dutch governments. It published the current rankings last month.

Novo Nordisk rose to second place, while Sanofi, based in France, dropped to eighth place from third and Pfizer fell to 16th from 11th. One Japanese company, Eisai, beat many American and European companies to reach 11th place.

The index has been refined over time. For example, the current edition includes access to drugs to treat schizophrenia and other mental illnesses. The earliest versions focused on infectious and tropical diseases.