The End of the International Reference Pricing System?

The attractiveness of using prices in other countries as a benchmark for decision-making is obvious. It's simple and transparent.

Trump understands this – his administration first announced plans to introduce IRP on U.S. Medicare Part B medicines back in October 2018. After almost two years of counterproposals and arguments on Capital Hill, Trump has resurrected the proposal with an executive order.

IRP has existed since the seventies, initially being implemented by Sweden in 1971. Today, with the exception of the U.K. and (oddly enough) Sweden, all countries within the larger European context employ some measure of IRP. And as times have changed, so have methods. Payers and manufacturers are also engaged in different types of access schemes - risk sharing, price-volume negotiations, payback arrangements, coverage with evidence developments – all linked to confidential discounts and rebates.

This 2015 article via the journal of Applied Health Economics and Health Policy (SpringerNature Digital) from two seminal researchers in Health-Technology-Assessment predicts the death of IRP. As prices are increasingly undisclosed, there will be no countries to reference.

While this will not eliminate the interest in comparing prices, it will eliminate the use of publicly-available prices as an instrument for a simple and transparent policy.