Swedish drug reimbursement authority the TLV has issued a new report comparing average branded pharmaceutical prices in Sweden with select international countries. The findings indicate that Swedish prices are in the middle range of the comparison group.
IHS Global Insight Perspective | |
Significance | The report is the closest that Sweden has come to an international reference-pricing mechanism, although the formal implementation of such reference pricing is also in the pipeline. |
Implications | There will be no specific pricing implications on individual drugs from the report; its purpose is more to ensure that there are no significant, general outliers among Sweden's pharmaceutical prices compared with other international countries. |
Outlook | This is not the first time Sweden's reimbursement agency has issued this kind of report, and it is likely that these kind of international comparisons will play a more directly influential role. |
The Swedish reimbursement agency, the TLV, has issued a new report on the evolution of branded pharmaceutical prices with an international perspective. The report focuses on 15 Western European countries and on medicines that were introduced between 2007 and 2011. The full report is available, in Swedish, here.
The key findings show that Sweden falls in the middle of the group of countries: seven countries have a higher average price (based on wholesale prices, AIP), and six countries have lower prices. Among the Nordic countries, against which the TLV tends to benchmark itself, Denmark has higher average prices, and Norway and Finland have lower prices. The 15 markets include Switzerland, Ireland, Germany, Denmark, Italy, Austria, Spain, Netherlands, Portugal, Norway, Belgium, Greece, the United Kingdom, and France.
Switzerland was shown to have the highest difference in price: average costs were 15% higher than Sweden. Prices in Ireland, Germany, Denmark, Italy, and Austria were also found to be higher—substantially so for Germany and Ireland. The Netherlands and Spain were shown to have marginally lower average prices (less than 1%), and France and the UK both had more than 10% cheaper average prices. Greece, Finland, Belgium, Norway, and Portugal all had prices that were 5–8% cheaper than Sweden.
The report also compared pharmaceutical prices of the best-selling prescription drugs on the market. Here, Sweden's prices are shown to be somewhat higher than the norm; only four countries have higher prices, and 11 countries have lower prices. Sweden is the most expensive market for a drug such as UK pharma GlaxoSmithKline's asthma medication Seretide (salmeterol + fluticasone), for example.
Still, the report highlights that the pricing corridors among the Western markets are relatively narrow. This is particularly true when looking at the new drugs that have been approved in 2007–2011; there is a striking alignment of pricing here. Among the top 15 best-selling drugs, no market is ever more than 57% cheaper than the Swedish market. There are a few outliers here—a drug like US pharma Pfizer's painkiller Lyrica (pregabalin) was found to be 154% more expensive in another market—but in general there is significant harmonisation of pricing trends.
Selected Top 15 Best-Selling Drugs in Sweden: International Comparison of Prices (2012) | ||||||
Drug | % of Swedish Basket of Drugs | % Price Difference from Median | Price Difference from Cheapest Country | Price Difference from Most Expensive Country | Number. of Countries Where Drug is Cheaper | Number of Countries Where Drug is More Expensive |
Enbrel | 8.4 | -14 | -21 | 22 | 11 | 3 |
Humira | 7.9 | -8 | -20 | 24 | 8 | 3 |
Lipitor | 3.9 | -10 | -35 | 17 | 7 | 3 |
Spiriva | 2.8 | -18 | -57 | 11 | 13 | 2 |
Recombinate | 2.7 | -20 | -50 | 88 | 6 | 2 |
Lyrica | 2.7 | -6 | -21 | 154 | 9 | 6 |
Lantus | 2.4 | -7 | -21 | 8 | 12 | 3 |
Concerta | 2.4 | -15 | -40 | 13 | 12 | 2 |
Seretide | 2.3 | -29 | -47 | -9 | 13 | 0 |
Glivec | 2.2 | -3 | -19 | 14 | 8 | 4 |
Avonex | 2.2 | -11 | -30 | 37 | 7 | 5 |
Novorapid | 2.0 | -12 | -27 | 36 | 10 | 5 |
Novomix | 1.9 | -6 | -14 | 34 | 10 | 5 |
Seroquel | 1.8 | -18 | -51 | 33 | 7 | 5 |
Aricept | 1.8 | -21 | -38 | 13 | 9 | 1 |
Source: TLV 2012 | ||||||
Outlook and Implications
The report appears to confirm Sweden's status as a middle-of-the-range country, where prices are rarely the lowest but also rarely the highest. Still, with the ongoing healthcare reform agenda and price cuts, the Swedish market has significant downward pressure and its outlook remains bleak. Certainly, its reputation as a market that provides fair pricing procedures is under threat. The full impact of these reforms will be felt more clearly in the 2012–14 period, and future reports of this nature should see average Swedish decrease significantly, although of course similar trends are being observed in many other markets that are engaging in more stringent cost-effectiveness, value-based pricing criteria.