Problem Statement: International Reference Pricing (IRP) is a price regulation tool widely used by policymakers to set drug price in the country considering its price in other country. IRP implementation might be problematic thereby policymakers need to carefully select the basket countries to achieve the intended outcomes. However, IRP implementation process or country experience is scarce in the literature.

Description: In Saudi Arabia, Saudi Food and Drug Authority (SFDA) is responsible for setting drugs public prices by several methods including IRP. According to the system, IRP policy is subjected to adjustment based on reference countries situations. However, appropriate methodology for IRP country clustering or adjustment was not definitive. Therefore, a systematic literature search was conducted in relevant databases to determine methodological considerations and countries selection criteria for IRP policy. Then, the national IRP policy was modified based on the identified criteria: similar socioeconomic conditions stratified by GDP per Capita, PPP and manufacturing activities, robust health systems and regulations, pricing policies, and geographic proximity. The identified criteria were modulated to fit the Saudi context and to address national public health needs. Stakeholders and Experts’ opinions were considered in IRP policy adjustment and in the selected basket countries. Before 2021, the initial IRP basket was composed of 30 countries, narrowed to 20 countries in 2021 and finally narrowed to 16 comparable countries based on the developed criteria in 2022. This reduced IRP complexity, minimized potential pricing errors and price appeals.

Lessons Learned: Choosing reference countries is problematic and should be operated based on a set of considerations to ensure faire pricing and access to drugs.

Stakeholder perspective: Government, regulatory, SFDA.