SynthesisThe European journal of health economics : HEPAC : health economics in prevention and care2020
Does external reference pricing deliver what it promises? Evidence on its impact at national level.
Synthesis in The European journal of health economics : HEPAC : health economics in prevention and care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Variations in external reference pricing implementation: does it matter for public policy?The European journal of health economics : HEPAC : health economics in prevention and care · 2019Pooled it
- Pricing of innovative medicines and advanced therapies worldwide: an scoping review.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- Structural drivers of drug shortages and market withdrawal: a longitudinal analysis of the Romanian pharmaceutical market.BMC health services research · 2026Article
- The impact of annual price revision based on external reference pricing on medicines between 2012 and 2023.Health economics review · 2026Article
- From Legislative Harmonization to Real-World Access: A Scoping Review of Pharmaceutical Regulation and Access to Medicines in Romania.Healthcare (Basel, Switzerland) · 2026Review
- Price determinants and pricing policies concerning potentially innovative health technologies: a scoping review.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- The impacts of pricing and reimbursement policies on access to cell and gene therapies across Europe.Journal of community genetics · 2026Review
- Collective international action to increase access to costly drugs: pooled procurement and equity based tiered pricing.BMJ (Clinical research ed.) · 2025Article
- From Vision to Reality: The EU's Pharmaceutical Reforms and the Path to Improved Access.PharmacoEconomics - open · 2025Article
- Determinants of orphan drug health technology assessment in South Korea: an empirical analysis.Frontiers in pharmacology · 2025Article
- Design and Features of Pricing and Payment Schemes for Health Technologies: A Scoping Review and a Proposal for a Flexible Need-Driven Classification.PharmacoEconomics · 2025Article
- Stakeholder engagement and pharmaceutical pricing regulation: a qualitative inquiry.Journal of pharmaceutical policy and practice · 2025Article
- Health technology assessment of medicinal products in Greece: a 5-year (2018-2023) review of timelines and productivity.International journal of technology assessment in health care · 2024Article
- Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience.Health economics review · 2024Article
- The Hurdle of Access to Emerging Therapies and Potential Solutions in the Management of Dyslipidemias.Journal of clinical medicine · 2024Review
- The impact of external reference pricing on pharmaceutical costs and market dynamics.Health policy OPEN · 2023Article
- Pricing and reimbursement mechanisms for advanced therapy medicinal products in 20 countries.Frontiers in pharmacology · 2023Article
- How does external reference pricing work in developing countries: evidence from Iran.Frontiers in pharmacology · 2023Article
- "What's up with price controls?" Stakeholders' views on the regulation of pharmaceutical pricing in Malaysia.PloS one · 2023Article
- Value and Price of Multi-indication Cancer Drugs in the USA, Germany, France, England, Canada, Australia, and Scotland.Applied health economics and health policy · 2022Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundExternal reference pricing (ERP) is widely used to regulate pharmaceutical prices and help determine reimbursement. Its implementation varies substantially across countries, making it difficult to study and understand its impact on key policy objectives.
objectivesTo assess the evidence on ERP in different settings and its impact on key health policy objectives, notably, cost-containment, pharmaceutical price levels, drug use, equity, efficiency, availability, affordability and industrial policy; and second, to critically assess the quality of evidence on ERP.
methodsPrimary and secondary data collection through a survey of leading experts and a systematic literature review, respectively, over the 2000-2017 period.
resultsForty five studies were included in the systematic review (January 2000-December 2016). Primary evidence was gathered via survey distribution to experts in 21 countries (January-July 2017). ERP contributes to cost-containment, but this is a short-term effect highly dependent on the way ERP is designed and implemented. Low prices, as a result of ERP, can undermine the availability of medicines and lead to launch delays or product withdrawals. Downward price convergence can hamper investment in innovation. ERP does not seem to promote efficiency in achieving health system goals. As evidence is weak, results need to be interpreted with caution.
conclusionsERP has not regulated prices efficiently and has unintended consequences that reduce the benefits arising from it. If ERP is carefully designed with minimal price revisions, prudent selection of basket size and countries, and consideration of transaction prices, it could be a more effective mechanism enhancing welfare, equitable access to medicines within countries and help promote industry innovation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.