OBJECTIVES: With Brazil becoming a key reference country in Latin America, pricing discussions at the country level have regional implications. Bargaining behavior in pricing and negotiations for oncology products in Brazil is leading to more price discounts and subsequent sub-optimal revenue goals for manufacturers. This study aims to investigate the common price discounts applied to innovative oncology drugs in Brazil.

METHODS: We analyzed all oncology drugs that received a positive recommendation from the Brazilian HTA agency (i.e., CONITEC) within the last 4 years (i.e., 2019-2022). For these, we identified their approved public list price and the reimbursed price set by the manufacturer during the HTA appraisal process. Descriptive analyses were conducted to assess the discount level offered.

RESULTS: From 2019 to 2022, 11 oncology drugs received a positive recommendation for reimbursement in Brazil. Of these, 5 involved innovative biologics and 6 innovative small molecules. The average discount offered by manufacturers was 28.8% ± 20.1%. The lowest discount offered was 4.6% for the use of blinatumomab in pediatric B-cell acute lymphoblastic leukemia, which involved a price reduction from $1,767.58 to $1,685.57 per vial. The highest discount offered was 78.2% for the use of crizotinib in metastatic non-small cell lung cancer, which involved a price reduction from $5,630.52 to $1,228.94 per package with 60 capsules. Discounts were mostly driven by clinical uncertainties and additional discussions on efficiency and affordability.

CONCLUSIONS: As manufacturers are looking to launch in Brazil, CONITEC is routinely seeking discounts on the public list price of oncology drugs to provide positive HTA recommendations. Understanding the local pricing landscape and the associated challenges, the clinical and economic drivers for discounts negotiations, and defining value-oriented submission strategies prior to the HTA appraisal is critical to ensure profitable revenues that align with commercial expectations and the financial sustainability of the healthcare system.