International price comparison 2020 An analysis of Swedish pharmaceutical prices in relation to 19 other European countries You are welcome to quote the Dental and Pharmaceutical Benefits Agency’s reports, but do not forget to cite the source: Name of the report, year, and the Dental and Pharmaceutical Benefits Agency. The Dental and Pharmaceutical Benefits Agency, December 2020 Reference number: 3740/2020 Postal address: P.O. Box 22520, 104 22 Stockholm Visiting address: Fleminggatan 18, Stockholm Telephone: 08 568 420 50 www.tlv.se Preface The Dental and Pharmaceutical Benefits Agency’s (TLV) shall, according to its’ mandate, monitor and analyse the pharmaceutical price development from an international perspective. TLV presents the results of the analysis, which is based on price and volume data for the first quarters during the period 2014 to 2020 in Sweden in comparison with 19 other European countries. The analysed segments are pharmaceuticals without competition and pharmaceuticals with competition. Pharmaceuticals with competition include pharmaceuticals available as substitutable pharmaceuticals in the product-of-the-month system as per March 2020. The working group for the report included David Sjöberg, Oskar Johansson, Daniel Högberg, and Per Hortlund. This year, extra focus has been on analysing why Sweden's relative price level for pharmaceuticals is higher when the pharmaceuticals have been on the market for a few years. In addition, descriptions of other countries have been updated which enable comparisons from other countries’ perspectives so that more people can make use of the results of the report. The report should be seen as a basis for TLV’s continuous monitoring of the dynamics of Swedish prices and how Swedish prices relate to prices in other countries. Agneta Karlsson Director-General Table of contents Preface ................................................................................................................... 3 Table of contents .................................................................................................. 4 Summary ............................................................................................................... 6 Terms and concepts ............................................................................................. 9 1 Introduction ...................................................................................................... 1 1.1 Assignment ............................................................................................... 1 1.2 Outline ....................................................................................................... 2 1.3 Methodology and data ............................................................................... 3 2 The pharmaceutical market ............................................................................. 5 2.1 Currency exchange rate ............................................................................ 5 2.2 Outpatient and inpatient care ..................................................................... 6 3 Price comparisons ........................................................................................... 9 3.1 Prices throughout the pharmaceutical life cycle ......................................... 9 3.2 Pharmaceuticals without competition ....................................................... 14 3.3 Pharmaceuticals with competition ............................................................ 23 3.4 Bilateral average – price comparison considering other countries’ volumes 31 4 Discussion ...................................................................................................... 33 Appendix 1: Sensitivity analysis and methodology ........................................... 1 1 Sensitivity analyses ................................................................................... 1 2 Methodology and data ............................................................................... 6 Appendix 2 Price and subsidy systems in Europe ............................................. 1 1 Sweden ..................................................................................................... 1 2 Finland ...................................................................................................... 3 3 Norway ...................................................................................................... 6 4 Denmark .................................................................................................... 8 5 Germany ................................................................................................... 9 6 United Kingdom ....................................................................................... 11 7 France ..................................................................................................... 12 8 The Netherlands ...................................................................................... 13 9 Belgium ................................................................................................... 15 10 Austria ..................................................................................................... 16 11 Ireland ..................................................................................................... 17 12 Italy ......................................................................................................... 18 13 Portugal ................................................................................................... 19 14 Switzerland .............................................................................................. 20 15 Spain ....................................................................................................... 21 16 Greece .................................................................................................... 22 17 Hungary ................................................................................................... 22 18 Czech Republic ....................................................................................... 23 19 Slovakia ................................................................................................... 23 20 Poland ..................................................................................................... 24 Appendix 3: Country-specific figures .................................................................. 1 1 Austria ....................................................................................................... 2 2 Belgium ..................................................................................................... 3 3 Czech Republic ......................................................................................... 4 4 Denmark .................................................................................................... 5 5 Finland ...................................................................................................... 6 6 France ....................................................................................................... 7 7 Germany ................................................................................................... 8 8 United Kingdom ......................................................................................... 9 9 Greece .................................................................................................... 10 10 Hungary ................................................................................................... 11 11 Ireland ..................................................................................................... 12 12 Italy ......................................................................................................... 13 13 The Netherlands ...................................................................................... 14 14 Norway .................................................................................................... 15 15 Poland ..................................................................................................... 16 16 Portugal ................................................................................................... 17 17 Slovakia ................................................................................................... 18 18 Spain ....................................................................................................... 19 19 Sweden ................................................................................................... 20 20 Switzerland .............................................................................................. 21 References............................................................................................................. 1 Summary This report is part of TLV’s mandate to analyse developments in the Swedish pharmaceutical market from an international perspective. The report is the seventh annual report of its kind. The report analyses Swedish prices over the pharmaceutical life cycle. The analysis compares the price level of pharmaceuticals used in Swedish outpatient care with 19 other European countries. The analysis is based on national pharmacy wholesale list prices. In several countries, there are agreements on discounts or repayments, meaning that the net cost of pharmaceuticals will ultimately be lower than the cost based on officially determined list prices. In Sweden, value-based pricing is used for