What a difference a year (or two) makes. When we published the 2017 edition of our International Reference Pricing Guidebook, we did so under the banner ” IRP is dead, long live IRP!” This was our nod to the fact that, in an era of managed-entry agreements, patient access schemes and other such instruments, a legitimate question has been posed over the longevity of IRP: to the extent that visible prices in reference markets increasingly mask varied types of concessions, has IRP outlived its usefulness?
As we remarked in the 2017 edition of our study, in the final analysis, IRP remains alive and kicking. Despite the inability to pierce the veil of confidential discounting, this policy tool continues to feature prominently in the pricing framework of many markets, mature and emerging alike.
As we currently finalize the 2019 edition of our Guidebook, we are struck by the extent to which the intervening period reinforces this observation.
Looking back over just the past few months, we’ve seen a veritable wave of IRP reforms:
- As of 1 April, Bulgaria’s reference basket has been streamlined and consolidated to do away with the old primary vs. secondary basket distinction; the IRP formula remains unchanged to reference the lowest price in the reference basket
- In Russia, late last year, a significant number of reference countries were axed from the basket, and more recently, provisions have been made for mandatory re-registration of prices
- Greece has seen a full overhaul of its pricing framework, introducing a new reference basket and IRP formula in the process
- In Ukraine, price controls involving IRP have now been extended to a subsection of the National List of Essential Medicines, relying on the same reference basket as the Affordable Medicines pilot, but introducing a new formula
- In Malaysia, the cabinet has approved new controls on pharmaceutical prices involving IRP, with implementation pending industry consultation
…. and the list goes on. Of course, the spectre of IRP introduction in the US, in one form or another, looms large in the background, with potentially game-changing consequences for industry.
This continued investment in IRP by payers and policymakers worldwide reflects appreciation for the utility of the tool. Often positioned alongside other decision-making criteria, or referred to in the context of negotiation, IRP continues to generate important benchmarks and points of leverage that payers are not so quick to relinquish.
For industry, amidst this backdrop of IRP policy churn, in-depth, nuanced insights on policy evolution are mission-critical. Maintaining a structured view of the many IRP parameters in each market – including basket composition, frequency of re-referencing, scope of medicines covered, exchange rate mechanisms, and more – is paramount in order to account for the complexity and interconnectivity of the global IRP landscape.
If there is a clear lesson from our work on the 2019 edition of the Guidebook so far, it is that IRP is decidedly less dead than it was in years prior.
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