OBJECTIVES: Identify within the top 5 EU countries where innovative pharmaceutical prices decrease the most. METHODS: Average price changes over time as well as average time to first price cuts were analysed for pharmaceuticals approved by the European Medicines Agency (EMA), priced in each market in 2009 and afterwards, which are still patent-protected and reimbursed in all analysed markets. RESULTS: Overall, the majority of the innovative drugs that are reimbursed and still patent-protected have not experienced a price change in each of the market studied since 2009. Over the period analysed, Germany and France are the countries where the largest number of innovative drugs experienced a price cut (around 37% of the samples analysed for both countries). Price cuts commonly occur after 1.2 year on average in Germany and 1.7 year in France. Drugs assessed under the AMNOG reform in Germany saw their prices drop by an average of 17%. In Italy, Spain and the United Kingdom, the part of innovative pharmaceuticals experiencing price cuts is more limited, 10.6%, 12.9% and 16.9%. Additionally, the average price cut is small. CONCLUSIONS: Within the EU top 5, price cuts for innovative pharmaceuticals are more likely to be implemented in Germany as well as in France.

• In Germany, the AMNOG reform has had a significant impact on prices of drugs that completed the process.
• In France, the majority of the price cuts occurred for drugs that are not deemed innovative (ASMR rating of IV or V); which are therefore not granted the European level price guarantee for a five-year period.

In Italy, Spain and the United Kingdom, price cuts do not occur regularly, at least at the list level. Other studies have demonstrated that prices tend to be lower at launch but are more likely to remain constant over time.