OBJECTIVES: The aim of this study was to compare annual prices of Orphan Drugs (ODs) available in five Middle East North Africa (MENA) countries: Lebanon, Morocco, Saudi Arabia, Turkey, and the United Arab Emirates (UAE).

METHODS: Ex-factory prices of ODs available in the 5 countries of the scope were extracted from IHS POLI database. The posology and treatment duration were used to calculate the ODs annual prices. Annual prices were adjusted using gross domestic product (GDP) per capita. Median as well as mean prices per country were calculated.

RESULTS: The UAE had the highest number of ODs with available prices (n=42) followed by Turkey (n=28), Lebanon (n=25), Saudi Arabia (n=21), and Morocco (n=4). The UAE also had the highest median annual prices of ODs (mean=150,436$ and median=70,046$), whereas Turkey had the lowest median annual prices (mean=26,539$ and median=15,664$). Compared to the UAE, OD prices ratios varied between 0.31 (Turkey) and 0.86 (Morocco). However, adjusting prices using GDP per capita showed that the countries with the lower purchasing power, Morocco and Lebanon, had nearly four to ten times higher relative costs (14.46, 6.95 respectively) than higher GDP countries (1.86 in UAE, 1.44 in Turkey and 2.5 in Saudi Arabia).

CONCLUSIONS: Our results confirmed the ODs affordability issue. The heterogeneity observed in OD prices within MENA countries may be explained by the difference in pricing policies (especially external price referencing) and specific countries’ economic climates. The risk of parallel trade may also drive prices higher in low GDP countries. Harmonization processes by reviewing the external price referencing and differential pricing may be potential solutions to improve the access of ODs and treatment of rare diseases in the MENA countries.