OBJECTIVES: Price increases for non-generic medicines within the pharmaceutical benefits scheme in Sweden are only granted in exceptional cases. The objective of this study was to determine relevant factors linked to the price increase decisions for prescription drugs in Sweden.

METHODS: The database for reimbursement decisions from the Swedish Dental and Pharmaceutical Benefits Agency was used to identify decisions regarding price increase applications of prescription drugs in Sweden between January 2019 and May 2020. Medicines were categorized according to the decision outcome, and the outcome was assessed quantitatively including the relative price increase. The published decision documents were qualitatively assessed, identifying relevant factors for the decision outcome.

RESULTS: During the study period, 27 medicines were subject to price increase applications of which 19 were granted a price increase. The number of rejected price increase applications might have been underestimated as applications could have been withdrawn before the decision. Medicines included among others human immunoglobulin therapies, laxatives, therapies for mental disorders, as well as therapies for patients who are at risk of an ischemic event. For most medicines, the reported price increase ranged between 0.6 and 5 times of the original price. The relative price increase varied between treatments and indications. Relevant factors regarding the price increase decision were the perceived severity of the condition and potential challenges linked to treatment interruption or switching, including the mode of administration, intolerance to treatment alternatives, and side effect profiles. Additionally, risks associated with a diminished supply, the availability of alternative treatment options, and the initial price level in comparison to other European countries were taken into consideration.

CONCLUSIONS: While the relative price increase varied between medicines, common factors were identified including the availability of treatment alternatives and potential challenges linked to a diminished supply.