Presentation (CTI)

OBJECTIVES: This analysis investigates how differences in cost of living across countries which might feasibly be referenced in a US ‘most-favoured nation’ (MFN) pricing policy, henceforth ‘MFN countries’, relate to pharmaceutical pricing and access to medicines. By comparing the US to peer nations with centralised pricing systems, we highlight disparities in affordability and access. The analysis also considers how recent US policies, including the Inflation Reduction ACT (IRA), may influence pricing equity.
METHODS: We conducted a comparative analysis of cost of living indices and drug prices across MFN countries, using publicly available data from Visual Capitalist and OECD sources. The US was used as a benchmark to measure the cost of living of other countries. We examined whether differences such as this one are proportionately reflected in drug prices and assessed the role of centralised pricing mechanisms, such as health technology assessment (HTA)-driven reimbursement in the UK, versus the historically decentralised US model.
RESULTS: Despite the cost of living being only 11% lower in the UK, drug prices there are often 60-70% lower than US Medicare prices. This disparity suggests that pricing is not solely driven by economic conditions, but by structural policy differences. Countries such as the UK with centralised HTA systems tie reimbursement to cost-effectiveness threshold, prompting equitable access. In contrast, the US lacks such mechanisms outside of recent Medicare reforms, contributing to high costs and access barriers for uninsured or underinsured populations.
CONCLUSIONS: This disconnect between cost of living and drug prices in the US highlights systemic inequities in access. As Medicare begins to negotiate prices under the IRA, prices could become more aligned with value and affordability, which could enhance equity. However, without broader structural reform, high prices will continue to limit access for vulnerable populations.