Pharmaceutical Pricing: The Use of External Reference Pricing.

External reference pricing, or international price comparison, is a common strategy to control prices of pharmaceuticals that are protected by intellectual property rights and benefit from a legal monopoly (in-patent drugs). In the UK negotiations are under way that seek to define new arrangements for the pricing of branded (new) medicines from 2014. The pharmaceutical market in the UK only accounts for a small proportion of global sales; however, UK prices are important as many countries reference their prices against those in the UK. This article seeks to contribute to our understanding of approaches to pharmaceutical pricing in high-income countries and the role of reference pricing as a means to determining pharmaceutical prices. Reviewing experiences in Canada, France, Germany, Italy, the Netherlands and Spain, we find high variability of external reference pricing across different settings and of the relative importance of this approach in comparison with other pricing strategies. There was also considerable variation in the terminology and practices used, and understanding the complexities of countries included in reference baskets for external pricing requires considerable semantic clarification. There was considerable overlap between countries that cross-reference, and it remains challenging to estimate the direct, immediate impact on external reference baskets. This review suggests that the international impact of pricing changes in the UK is likely to be minimal or indirect, largely because of the diverse ways in which reference pricing is implemented in the countries examined.