Factors Influencing Orphan Drug Net Prices in the EU4 and US – Insights from Payers
Author(s)
Ergin Y1, Rex M1, Yadav V1, Hasson O2, Haney E1
1Inbeeo Ltd, London, UK, 2Inbeeo Ltd, London, LON, UK
Presentation Documents
OBJECTIVES: List prices often do not reflect prices healthcare systems pay for technologies. Confidential discounts in the form of rebates or managed entry agreements make it challenging to estimate net prices. Orphan drugs (ODs) are often associated with high costs and complex pricing mechanisms. In this study, we explore factors driving confidential discounts for non-oncology ODs across the EU4 and US.
METHODS: Two payer experts from each market (n=10) were interviewed to understand the factors influencing net prices for ODs. Non-oncology ODs approved by the European Medicines Agency (EMA) between 2017-2023 were identified. To compare list prices, products were filtered based on availability of annual list prices in all scope markets, using the NAVLIN® database. Confidential discount estimates from payers were applied to list prices to arrive at estimated net prices.
RESULTS: Of 68 identified ODs, 17 had visible list prices across all scope countries. Average annual list prices ranged from €429,160 in the US to €250,757 in France.
Payers identified competition as the key factor driving confidential discounts for ODs. Expected confidential discounts for ODs with vs without competition were -18% vs 0% in Germany, -20% vs -10% in France, -25% vs 0% in Italy, -25% vs 0% in Spain, and -20% vs 0% in the US. ODs that launched without competition had significantly higher average annual estimated net prices compared to ODs with competition, ranging from +98% (France) to +226% (Spain), driven by lower discount levels and higher list prices.CONCLUSIONS: Competition gives payers increased leverage to negotiate confidential discounts for ODs across the EU4 and US. ODs launching with competition typically have lower list prices than ODs without competition, however this difference is larger once discounts are considered. A more nuanced understanding of OD net price setting can help strategic planning for both healthcare systems and manufacturers.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
HPR102
Topic
Health Policy & Regulatory
Topic Subcategory
Pricing Policy & Schemes, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Rare & Orphan Diseases