OBJECTIVES: Against the background of recent pharmaceutical pricing controversies in the United States, this analysis seeks to provide a more comprehensive and nuanced comparison of prices in the US with those in Europe, including how they evolve over time and how list prices compare to negotiated prices. METHODS: Two samples were used:

RESULTS: List prices were higher in the United States by an average of 67% over those in the EU Top 5. In the US, manufacturer prices increased by 23% over the period examined. Prices increased for 76.7% of the sample. In the EU top 5, prices of these same pharmaceuticals decreased from 1% in Spain down to 17.8% in Germany. Negotiated pharmaceutical prices are slightly lower than manufacturer prices. Interestingly, the price premium in the United States over Europe was higher in the second sample (of older pharmaceuticals) than in the first sample, although prices tend to increase over time in the US (and decrease in Europe). CONCLUSIONS: Price comparisons between the US and Europe often paint a skewed picture in the absence of non-estimated data on net and discounted prices. Pharmaceutical prices across the full spectrum of available prices in the US are still higher than in Europe and continue to increase over time. The trend in Europe is opposite: prices are lower and tend to decrease. The difference is less pronounced among pharmaceutical prices that are negotiated in the United States.