Pharmaceutical net price transparency across European markets: Insights from a multi-agent simulation model

Abstract

In innovative drug markets the widespread practice across the EU of country-specific confidential agreements reached between national payers and innovative pharmaceutical manufacturers continues to be a highly disputed basis for pharmaceutical health policy making. With pharmaceutical health policy striving for fair and sustainable pricing under increasing budgetary pressures, public stakeholders are more and more willing to be involved in transparent access decision-making related to novel medicines, considered to be a societal good. Full net price transparency is believed by many to promote price competition and to increase equity by making presently unaffordable pharmaceutical products accessible to patients in lower-income markets. To investigate the viability of a net price transparency (NPT) system we develop and analyse a multi-agent model representing the European country-level situation to conduct counterfactual analyses of various NPT systems. In line with previous recent NPT research in other geographical, regulatory and market contexts, we find that a full NPT system encompassing higher- and lower-income EU countries would not be viable. This while, counterintuitively and acting as rational economic agents, middle- and lower-income countries would not be deciding to join and give up their confidential agreement system with the pharmaceutical industry. Also, a full NPT system would be seen to be unjust while violating Ramsey pricing and distributive justice principles. Maximally, a partial price transparency system could be a viable solution if entailing only the group of high-income countries including UK and Germany committing to NPT, leaving all other countries free to opt for confidential discounts. Viability of this solution is contingent upon UK or Germany accepting a higher price than they could get in their present confidential rebate system. Finally, in a dynamic game theoretic analysis, we show that middle- and lower-income countries, might be joining the high-income group later. In any case, a net price transparency system would delay access in middle- to lower-income countries. Hence, we conclude that even a partial transparency system would be a challenging case to reach from a political perspective and it will negatively impact population health improvement by the novel therapy, especially in lower-income countries.