World Health Systems Facts currently has sections on the US and sixteen other OECD nations. The links below lead directly to national sections on Pharmaceutical Pricing and Regulation:
“In 2021, spending on retail pharmaceuticals (that is, excluding those used during hospital stays and in other health facilities) accounted for one-sixth of overall healthcare expenditure in OECD countries. While retail pharmaceuticals continued to represent the third largest component of health expenditure after inpatient and outpatient care, spending on these goods has increased at a slower pace than most other areas of the health system over the last decade (see section on “Health expenditure by type of service” in Chapter 7), due to cost-control measures and generic uptake.
“Across OECD countries, governments and compulsory insurance schemes are the main payers of retail pharmaceuticals, financing 58% of total spending in 2021 (Figure 9.1). In countries such as France, Ireland and Germany, this share was even higher, with more than 80% of total costs covered by these schemes. Direct out-of-pocket payments by households (including cost-sharing for reimbursed medicines) were also a significant source of financing, representing an average of 39% of total pharmaceutical spending in 2021, albeit with much higher shares in countries such as Chile (78%), Poland (65%) and Latvia (59%). Out-of-pocket spending was also high in OECD accession countries Bulgaria and Romania. In contrast, voluntary health insurance schemes accounted for a relatively small proportion of total costs, at 7% or less in all but two OECD countries with comparable data (and averaging 3%). Canada and Slovenia are exceptions, where voluntary private health insurance accounted for 34% and 25%, respectively, of retail pharmaceutical spending.”
Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.
“A variety of factors influence the level of per capita spending on retail pharmaceuticals, including distribution, prescribing and dispensing; pricing and procurement policies; and patterns of uptake of novel and generic medicines. In 2021, per capita retail pharmaceutical expenditure in OECD countries averaged USD 614 (adjusted for differences in purchasing power) (Figure 9.2). Spending in the United States was more than double the OECD average, while the majority of OECD countries fell within a relatively narrow spending band of ±20% from the average. Per capita spending was lowest in Denmark, at less than half the OECD average. In that country, a comparably high proportion of medicines is dispensed as part of inpatient or outpatient treatments and thus outside traditional retail channels.”
Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.
“Global supply chains for active pharmaceutical ingredients (APIs) are highly centralized in certain countries and are susceptible to supply-chain shocks. However, there is no systematic monitoring or global coordination to manage risk and ensure equitable supply continuity during public health emergencies. In this study, we applied quasi-experimental methods on shipment-level customs data to determine how prices and export volume for APIs exported from India were affected by the COVID-19 pandemic. We found that API prices for key essential medicines not used for COVID-19 did not change significantly in the year after the World Health Organization pandemic declaration, but volume decreased by 80 percent. Prices for medicines speculatively repurposed for COVID-19, such as hydroxychloroquine and ivermectin, increased by as much as 250 percent compared with prices for non-repurposed medicines, but only ivermectin saw a decrease in volume. Systematic monitoring of API markets, investments to promote supply diversification, and legal and political reforms to disincentivize price speculation could support supply-chain resilience and safeguard access to medicines.”
Source: Melissa Barber, Reshma Ramachandran, and Suerie Moon. Estimating The Effects Of COVID-19 On Globalized Markets For Active Pharmaceutical Ingredients. Health Affairs 2024 43:7, 959-969
“Pharmaceutical spending has two main components: prescription medicines and over-the-counter (OTC) products. Across OECD countries, prescription medicines accounted for more than three-quarters of the total pharmaceutical retail bill. The split between prescriptions and OTC products is influenced by country-specific differences in the coverage of prescription medicines, as well as the prices and availability of different medicines. Poland was the only OECD country where spending on OTC products exceeded that of prescription medicines.”
Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.
“Analysing retail pharmaceutical spending only gives a partial picture of the cost of pharmaceuticals in the health system. Spending on medicines in the hospital sector and other settings can be significant – typically accounting for 20% or more on top of retail spending (Morgan and Xiang, 2022[1]). Over the last decade, hospital pharmaceutical spending hasgrown substantially, partly due to the advent of new high-cost treatments, particularly in oncology and immunology (IQVIA Institute for Human Data Science, 2021[2]). Hospital and other non-retail pharmaceutical spending increased more rapidly than retail medicines in most countries, with the highest growthrates in Germany, Spain and the Czech Republic (Figure 9.3).”
Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.
“Pharmaceutical expenditure accounts for a variable share of current health expenditures across OECD and EU countries, ranging from 7% (reported by Denmark of Norway) to 41% (in Bulgaria) in 2016.1 The advent of the direct acting anti-virals (DAAs) for hepatitis C, the increasing use of high cost biologics, and the escalating launch prices of oncology medicines in particular, have raised concerns that pharmaceutical expenditure growth will become increasingly difficult to predict and may become challenging to sustain.”
Source: OECD (2019). Improving Forecasting of Pharmaceutical Spending – Insights from 23 OECD and EU Countries. Analytical Report.
“Per capita retail pharmaceutical expenditures, adjusted for purchasing power, among countries included in this study ranged from 324.6 (Denmark) to 741.1 US$ PPP (Germany) per capita in 2014 (see Figure 2.1). Ireland, France, Greece and Belgium were at the upper end of this spectrum below Germany, while the Netherlands, Portugal and Poland were at the lower end above Denmark. From a longitudinal perspective, while some countries show6 a relatively stable upwards trend (for example, Austria, Germany and Poland), in others per capita expenditures on retail medicines have been decreasing (for example, Portugal as of 2009, and the Netherlands as of 2011). Following a stable upwards trend until 2009, available data for Greece during the financial crisis years show a dramatic decline in per capita expenditure after 2011.
“Varying per capita expenditures for pharmaceuticals among countries can be attributed to different consumption rates (for example, for different indication areas, see section on consumption below) – the so-called volume component – differences in the utilization of new, mostly high-priced medicines and established, mostly low-priced medicines – the so-called structural component – and finally different prices per pharmaceutical – the so-called price component.”
Source: Panteli D, Arickx F, Cleemput I, Dedet G, Eckhardt H, Fogarty E, Gerkens S, Henschke C, Hislop J, Jommi C, Kaitelidou D, Kawalec P, Keskimäki I, Kroneman M, Lopez Bastida J, Pita Barros P, Ramsberg J, Schneider P, Spillane S, Vogler S, Vuorenkoski L, Wallach Kildemoes H, Wouters O, Busse R. Pharmaceutical regulation in 15 European countries: Review. Health Systems in Transition, 2016; 18(5):1–118.
“Across the 79 drugs in our sample, the average list price per dose was $152.92, ranging from $0.086 to $16,597.7 Annual pharmaceutical spending per capita varied from $318 in Denmark to $1,220 in the United States. Average annual per capita spending on pharmaceuticals was $675.25 across the 12 countries, $625.73 excluding the U.S. U.S. drug prices are on average outliers relative to all comparator countries. Most countries had average drug prices around 24 to 30 percent of those in the United States. The greatest disparity was with Japan, where the average drug price was only 15 percent that of the U.S., meaning that the U.S. on average spends seven times what Japan pays for the same drugs. Denmark represented the closest average price, where average drug prices were 39.1 percent of the average U.S. drug price.”
Source: “A Painful Pill To Swallow: US vs International Prescription Drug Prices,” US House Ways and Means Committee, Sept. 2019.
“Pharmaceutical expenditure can also be viewed in relation to the total expenditure on health and expressed as a percentage. Among compared countries, retail pharmaceutical expenditure as a share of current1 expenditure on health in 2014 amounted to 14.5% on average with a median of 14.1% and a range of 6.7% (in Denmark) to 28.4% (in Greece). Overall, retail pharmaceutical expenditure as a share of current expenditure on health shows relative stability both in directionality and positioning among compared countries (see Fig. 2.2) and has declined on average since 2004 (average excluding the Netherlands and the United Kingdom 18.1%, median 17.0%). A higher ranking here compared with the per capita observations in Fig. 2.1 (for example, Poland, Portugal) could mean that either pharmaceutical consumption is above average compared to other health services or that price levels are higher compared to other areas of care, which are mainly shaped by personnel costs. Conversely, a substantially lower rank (for example, Austria, Sweden) may indicate lower pharmaceutical consumption or prices.”
Source: Panteli D, Arickx F, Cleemput I, Dedet G, Eckhardt H, Fogarty E, Gerkens S, Henschke C, Hislop J, Jommi C, Kaitelidou D, Kawalec P, Keskimäki I, Kroneman M, Lopez Bastida J, Pita Barros P, Ramsberg J, Schneider P, Spillane S, Vogler S, Vuorenkoski L, Wallach Kildemoes H, Wouters O, Busse R. Pharmaceutical regulation in 15 European countries: Review. Health Systems in Transition, 2016; 18(5):1–118.
“Finally, another approach towards assessing and contextualizing pharmaceutical expenditure is looking at its share in gross domestic product. In 2014 both the average and the median shares of retail pharmaceutical expenditure among compared countries lay at 1.4% – compared to 1.5% and 1.6% respectively in 2004. Following outlier Greece (with 2.3%), France, Spain and Germany build the upper cluster in the sample with values between 1.60% and 1.67%, while Denmark (0.71%) and the Netherlands (0.83%) are at the lowest end of the spectrum. Varying degrees of contraction in the GDP of compared countries following the financial crisis should be taken into account when interpreting these figures.
“The relative stability of expenditure as a percentage of GDP in contrast to a falling percentage of current health expenditure can be explained by the fact that in many countries within the sample expenditure on other services and goods has increased at a speed above GDP growth, while expenditure on “retail” pharmaceuticals has grown in line with GDP. Another contributing factor may be the availability of generic products following patent expiry of originator medicines.
“Pharmaceutical expenditure as a share of GDP (shown in Fig. 2.3) emerges as a direct multiplication of current health expenditure as a share of GDP (Fig. 2.4) and the share of current health expenditure spent on “retail” pharmaceuticals (Fig. 2.2). In 2014 current expenditure on health amounted to an average of 9.0% of GDP in OECD countries and 9.8% among studied countries (median 10.1%), up from 8.4% and 8.3% respectively in 2004. Sweden led the sample in 2014 with 11.2%, followed by France and Germany with 11.1% and 11.0%, respectively. For the majority of countries in the sample a clear upwards trend can be discerned until 2009, with levelling off or declining tendencies after that. As of 2010, current expenditure as a share of GDP (including both public and private spending) has increased again for a number of countries, albeit seemingly at a slower pace.”
Source: Panteli D, Arickx F, Cleemput I, Dedet G, Eckhardt H, Fogarty E, Gerkens S, Henschke C, Hislop J, Jommi C, Kaitelidou D, Kawalec P, Keskimäki I, Kroneman M, Lopez Bastida J, Pita Barros P, Ramsberg J, Schneider P, Spillane S, Vogler S, Vuorenkoski L, Wallach Kildemoes H, Wouters O, Busse R. Pharmaceutical regulation in 15 European countries: Review. Health Systems in Transition, 2016; 18(5):1–118.
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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other nations.
Page last updated July 18, 2024 by Doug McVay, Editor.