OBJECTIVES: List prices for prescription drugs in the United States (US) tend to be higher than those in most peer countries. Health technology assessment (HTA) authorities in the United Kingdom (UK) and France produce independent assessments of the value of novel drugs. These assessments inform pricing, making drug prices in Europe close to their theoretical value-based price (VBP). The Institute for Clinical and Economic Review (ICER) recommends health-benefit price benchmarks (HBPB) that have a similar but distinct function in the US market. This study aims to compare HBPBs for novel drugs to list prices in the US, UK and France.

METHODS: We identified all brand-name prescription drugs for which ICER estimated a HBPB between January 2020-June 2022 that were approved by both the FDA and EMA. HBPBs were obtained from ICER evidence reports and list prices were obtained from the IBM Micromedex RED BOOK (US), the Monthly Index of Medical Specialities (UK), and the Ministère des Solidarités et de la Santé (France). HBPBs and drug prices were adjusted for inflation and converted to Euros.

RESULTS: ICER recommended a lower adjustment to the US list price for almost all drugs in the sample set (92.9%). ICER’s prices were consistently lower than prices in the UK and France (71.4% and 64.3% of comparisons, respectively). In aggregate, prices in France were closest to ICER’s recommendations. Prices in France were also less than those in the UK for 85.7% of comparisons.

CONCLUSIONS: This international comparison suggests that, even in countries where drug prices are highly negotiated, the average list prices exceeded ICER-estimated HBPBs. Differences across value-assessment frameworks and healthcare system factors may drive these differences. However, it is possible that if manufacturers adopted a more strategic approach to the ICER review process, similar to their engagement with European HTAs, less international price variation would be expected.