![]() ![]() Two studies of the Single Exit Price program in South Africa are mentioned in the systematic review of the WHO. However, the evidence that net price transparency (NPT) per se leads to lower prices is extremely limited and the generalizability of results is unclear. Monopsonist public payers enter into a bargaining process with innovative pharmaceutical manufacturers, the latter exhibiting monopolist behavior, at least for their most innovative disease-modifying therapies, which are believed to lead to unsustainable prices. Policy interventions by European payers have led to pricing regulations that have taken medicinal markets away from perfect competition. In particular, the WHO guideline on country pharmaceutical pricing policies suggests that countries should “Share the net transaction prices of pharmaceutical products with relevant stakeholders, within and external to the country”. Price transparency is currently a heavily debated topic in pharmaceutical markets after the resolution of the World Health Assembly in 2019 to “take appropriate measures to publicly share information on the net prices of health products”. ![]() This while, counterintuitively, in those countries NPT will be seen to be unjust while violating Ramsey pricing and distributive justice principles. Especially in lower-income countries there would remain a plea to be left free to negotiate confidential discounts with drug manufacturers. Hence, we conclude that implementing net price transparency across Europe would be challenging to reach from a political perspective. Even partial NPT would delay access predominantly in middle- to lower-income countries. This while, acting as rational economic agents, a group of middle- and lower-income countries would not be willing to give up their confidential agreements with the pharmaceutical industry. Using agent-based simulations, we find that a full NPT system implemented across EU countries would not be viable. Full net price transparency (NPT) is believed by many to promote price competition and to increase equity by making pharmaceutical products accessible to all. With pharmaceutical health policy striving for fair and sustainable pricing under increasing budgetary pressures, public stakeholders are more and more willing to be involved in transparent access decision-making related to novel medicines, considered by them to be a societal good.
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