OBJECTIVES: During 2011-2012 significant price cuts were implemented in various markets in the European Union. These price cuts have introduced new pricing dynamics affecting reference pricing and intra-EU parallel export of expensive drugs. METHODS: To understand new pricing dynamics in the big five EU (UK, France, Germany, Italy and Spain) we analyzed the trend in pricing for branded and biosimilar GM-CSF products. Prices were analyzed for percentage discount compared to branded GM-CSF product and relative price levels in five selected markets. Recent reimbursement policy changes and price cuts were also analyzed. RESULTS: The 2012 prices for GM-CSF products show significant variation across the UK, France, Germany, Italy and Spain. The prices for GM-CSF products were dramatically lower in Spain and the UK compared to France, Germany and Italy. For example, for branded GM-CSF product prices in Spain were 80% lower than prices in the UK. Similarly, the prices for biosimilar GM-CSF products were 72% lower in Spain than in the UK. The percentage price discount for biosimilar products versus branded product also shows large variation in big five EU markets. For example, Spain and the UK prices were almost at parity while the prices in France, Germany, and Italy showed 12%, 31% and 26% discount, respectively. CONCLUSIONS: Recent pricing reforms have significantly changed the pricing dynamic across the big five EU markets. Case study of GM-CSF products illustrates wide variation in pricing for branded and biosimilar products.