Patients’ access to drugs with rebates in Switzerland - Empirical analysis and policy implications for drug pricing in Europe.

A new study published in the Lancet from the University of Zurich finds that using confidential-discounts does little to improve patient-access at more affordable prices.

Switzerland has been using rebates since 2012. Starting 2019, some of these discounts have been kept confidential. The study examined all drugs granted rebates in Switzerland and all new drugs without rebates between January 2012 and October 2020.

The number of drugs with a rebate increased from one in 2012 to 51 drugs by October 2020. Of these, at least 14 had no information available to the public about the amount of the rebate or the price paid to pharma manufacturers. The majority were cancer drugs (63%) and only a third (29%) had high clinical benefit.

The study also found that offering rebates typically takes almost three-times as long from product-approval and price-determination. The median number of days to establish a price for drugs with rebates was 302 compared to 106 for those without rebates.

Switzerland, along with many of its European neighbours, uses external reference pricing to set drug prices. However, the practicality of this approach is being questioned over the last several years given the increasing use of confidential discounts.

The study comes as Switzerland and many other countries have signed confidential COVID-19 vaccine deals with drugmakers, raising issues on equitable-access and vaccine-nationalism.