OBJECTIVES: International reference pricing (IRP) is a price control mechanism, whereby medicine prices are calculated based on their prices in other markets to ensure the country determines an appropriate price. IRP is used extensively to determine the launch price of new pharmaceuticals in Europe and some countries utilise IRP during product re-evaluations. The aim of this research is to determine how consistently IRP is applied in pharmaceutical price re-evaluation in Romania, Switzerland, Slovenia and Turkey.

METHODS: To be included in the analysis, countries had to use IRP at pharmaceutical price re-evaluation, have had stable IRP rules over the past five years and refer to no more than 12 countries. Thus, four markets were identified - Romania, Switzerland, Slovenia and Turkey. Five retail products (Jardiance, Brintellix, Relvar Ellipta, Enstilar, Entresto) and five specialty products (Eylea, Ofev, Uptravi, Lymparza, Actilyse) were analysed. Historic price data from 2017-2022 was extracted from public price records. Analysis was conducted to compare the IRP price against the published price at an ex-factory level.

RESULTS: Across all products and countries in scope, the overall deviation of the public ex-factory prices from the IRP prices in the period 2017-2022 was 10.6%. Romania was associated with the lowest price difference (6.3%). In Turkey, Slovenia and Switzerland publicly available prices deviated with 16.5%, 16.8% and 19.4% from the IRP ones for all products, respectively. Specialty products were associated with a greater price differential (12.3%) than retail products (8.9%) across all markets.

CONCLUSIONS: In conclusion, this analysis shows that Romania applies IRP at price re-evaluation more consistently than Switzerland, Slovenia, and Turkey. Also, prices of retail products are generally more aligned with IRP rules than specialty products. It would be interesting to continue to monitor these prices to see if IRP is applied more stringently at national price re-evaluations.