OBJECTIVES: Flat pricing of medicinal products is an example of value-based pricing in which price is linked to the therapeutic value brought by the strengths, rather than price per milligram of the active substance, also known as linear pricing. This research aims to identify if countries in the EU4 (France, Germany, Italy and Spain) and United Kingdom are implementing value-based pricing decisions.

METHODS: We looked for innovative products with European Union marketing authorisation granted between 2018 and 2020. Selection criteria were oral administration route, availability of at least two strengths for the same indication, and same once-daily dosing schedule between strengths. EMA SmPCs were consulted to confirm criteria. Selected products were baricitinib, fesoterodine, filgotinib and hydrocortisone modified-release tablets. We collected the ex-factory prices for these products in each country, followed by a review of pricing legislation in each country to understand if value-based pricing was supported by local legislation.

RESULTS: In France and the UK, flat pricing decisions were observed for all products where flat pricing was expected, and this was supported by pricing legislation in both countries. In Spain and Germany, heterogeneous decisions were noted, which were aligned with country legislations that consider both the added therapeutic value and the defined daily dose for pricing rules, explaining some linear price decisions. In Italy, there was a trend for linear pricing, although legislation includes opportunity for value-based pricing, describing added therapeutic value and dosing schedules as criteria for pricing decisions.

CONCLUSIONS: Flat pricing is more difficult to achieve in Italy, with potential challenges to value-based flat pricing in Germany and Spain. Local legislation suggests that manufacturers may be able to support requests for flat pricing by calling out similar added therapeutic value and similar dosing schedule across strengths. These findings should be confirmed with research covering a greater number of analogue products.