title: Payers' experiences with confidential pharmaceutical price discounts: A survey of public and statutory health systems in North America, Europe, and Australasia.
abstract: Institutional payers for pharmaceuticals worldwide appear to be increasingly negotiating confidential discounts off of the official list price of pharmaceuticals purchased in the community setting. We conducted an anonymous survey about experiences with and attitudes toward confidential discounts on patented pharmaceuticals in a sample of high-income countries. Confidential price discounts are now common among the ten health systems that participated in our study, though some had only recently begun to use these pricing arrangements on a routine basis. Several health systems had used a wide variety of discounting schemes in the past two years. The most frequent discount received by participating health systems was between 20% and 29% of official list prices; however, six participants reported their health system received one or more discount over the past two years that was valued at 60% or more of the list prices. On average, participants reported that confidential discounts were more common, complex, and significant for specialty pharmaceuticals than for primary care pharmaceuticals. Participants had a more favorable view of the impact of confidential discount schemes on their health systems than on the global marketplace. Overall, the frequency, complexity, and scale of confidential discounts being routinely negotiated suggest that the list prices for medicines bear limited resemblance to what many institutional payers actually pay.
authors.affiliation: School of Population and Public Health, University of British Columbia, #267-2206 East Mall, Vancouver, BC V6T 1Z3, Canada. Electronic address: steve.morgan@ubc.ca.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Morgan
authors.affiliation: WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Vienna, Austria.
authors.forename: Sabine
authors.initials: S
authors.lastname: Vogler
authors.affiliation: Drug Policy Research Group, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, USA.
authors.forename: Anita K
authors.initials: AK
authors.lastname: Wagner
mesh_terms: D044362:Australasia; D003219:Confidentiality; D003365:Costs and Cost Analysis / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data*; D004345:Drug Industry / Q000191:economics*; D005060:Europe; D006801:Humans; D017008:Negotiating; D009656:North America; D011795:Surveys and Questionnaires
keywords: Coverage; Discounts; Pharmaceuticals; Prices; Rebates; Reimbursement; Survey