[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-176803-105":3,"detail-sidebar-cat-1-en-105":85,"doc-detail-176803-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":78,"head_meta":80,"extra_data":82,"updated_unix":84},105,"en","external-reference-pricing-implementation-does-it-matter-for-public-policy","External Reference Pricing Implementation - Does it Matter for Public Policy?","","External reference pricing (ERP) uses foreign drug prices as benchmarks to set domestic prices and often serves as a starting point for negotiations between health authorities and pharmaceutical manufacturers. A systematic literature review mapped ERP implementation characteristics across 29 countries, complemented by surveys of key stakeholders when published information was outdated or sparse. Evidence was benchmarked against 14 best-practice principles. Results show substantial cross-country heterogeneity. Policy consequences include falling global prices, launch delays, reduced R&D incentives, and diminished medicine access.",{"@graph":14,"@context":77},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/presentations/","Presentations",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/external-reference-pricing-implementation-does-it-matter-for-public-policy/176803/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/external-reference-pricing-implementation-does-it-matter-for-public-policy/176803.png","ImageObject",442,249,{"name":42,"@type":43},"Aditya","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-10-19","2026-09-02",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69,73],{"name":60,"@type":61,"acceptedAnswer":62},"What is external reference pricing (ERP) and what is its main purpose?","Question",{"text":63,"@type":64},"ERP uses drug prices from other countries as benchmarks to set or negotiate domestic prices. Its primary aim is to control in-patent drug prices by containing pharmaceutical prices and expenditure.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was ERP implementation assessed in the study?",{"text":68,"@type":64},"A systematic literature review identified ERP characteristics across 29 countries. Surveys of key stakeholders supplemented the review when information was outdated or limited, and results were compared against 14 best-practice principles.",{"name":70,"@type":61,"acceptedAnswer":71},"What did the study find about ERP implementation across countries?",{"text":72,"@type":64},"The study found significant heterogeneity in how ERP is implemented, including differences in basket size, pricing calculations, and the frequency of price revisions. Some countries aligned more closely with best practices than others.",{"name":74,"@type":61,"acceptedAnswer":75},"What policy impacts result from the observed heterogeneity in ERP?",{"text":76,"@type":64},"Heterogeneity has implications such as globally declining pharmaceutical prices, launch delays in lower-income countries, weaker incentives to continue R&D, and reduced access to medicines. The study suggests that benefits require sustainable, transparent, simple, and stable systems supported by key guidelines.","https://schema.org",{"og:url":32,"og:type":79,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":81,"canonical":32},"index,follow",{"doc_id":83,"site_id":7},176803,1791725093,{"code":4,"msg":86,"data":87},"success",[88,92,97,102,107,112,117,122,127],{"id":89,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":90,"slug":91},11,90,"presentations",{"id":93,"doc_module":22,"doc_module_name":25,"category_name":94,"show_sort_weight":95,"slug":96},12,"Resumes",80,"resumes",{"id":98,"doc_module":22,"doc_module_name":25,"category_name":99,"show_sort_weight":100,"slug":101},14,"Invoices",70,"invoices",{"id":103,"doc_module":22,"doc_module_name":25,"category_name":104,"show_sort_weight":105,"slug":106},15,"Posters",60,"posters",{"id":108,"doc_module":22,"doc_module_name":25,"category_name":109,"show_sort_weight":110,"slug":111},16,"Social Media",50,"social-media",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},17,"Forms",40,"forms",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},18,"Letters",30,"letters",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":125,"slug":126},21,"Paper Templates",5,"papers-templates",{"id":128,"doc_module":22,"doc_module_name":25,"category_name":129,"show_sort_weight":4,"slug":130},158,"General","general-158",{"code":4,"msg":86,"data":132},{"doc_id":83,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":22,"category_id":89,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":140,"language":141,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":12,"update_tm":145,"read_time":146},962085564549,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Variations in External Reference Pricing Implementation – Does it Matter for Public Policy?\nJennifer Gilla*, Anna-Maria Fontriera, Dionysis Kyriopoulosa & Panos Kanavosa\nAuthor Affiliations: a Department of Health Policy and LSE Health - Medical Technology Research Group, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK\n*Corresponding author:\nDr Jennifer Gill\nDepartment of Health Policy\nLSE Health - Medical Technology Research Group\nCowdray House\nLondon School of Economics and Political Science\nHoughton Street\nLondon WC2A 2AE\nUK\nTel: +44 (0)20 7106 1195\nEmail: \u0013 HYPERLINK \"mailto:J.Gill7@lse.ac.uk\" \u0014J.Gill7@lse.ac.uk\u0015\nAbstract\nBackground - External reference pricing (ERP) seeks to rationalize prices and contain costs by using foreign prices as a reference for the determination of domestic prices and is often used as the starting point for the facilitation of negotiations between health authorities and pharmaceutical manufacturers.\nMethods - A systematic literature review was used to identify characteristics of ERP implementation across 29 countries. Primary data collection, in the form of surveys directed at key stakeholders, were also used to supplement data in instances where information received from the systematic literature review was outdated or minimal. Findings from the systematic literature review and primary evidence from key stakeholders were bench-marked against 14 best practice principles inherent to an optimal ERP system.\nResults - Significant heterogeneity in ERP implementation across countries was identified. Country basket size, pricing calculation, frequency of price revisions varied between countries. Belgium, France, and South Africa were more likely to adhere to the best practice principles whilst Bulgaria, Hungary and Romania had the most instances of non-adherence.\nConclusion - The observed heterogeneity has policy implications for governments including globally declining pharmaceutical prices, launch delays in lower-income countries, reduced incentive for continued R&D and reduced access to medicines. Overcoming this issue to ensure that ERP is beneficial to all stakeholders will require a focus on developing sustainable, transparent, simple and stable systems using a set of key guidelines that should maximise the benefits of the pricing policy.\nKey Words: External reference pricing; Pharmaceutical policy; Regulation of Pharmaceuticals; Systematic Review; Expert consultation.\nJEL Classification: I, I1, I10, I11, I18\nAcknowledgements:  We would like to thank Mackenzie Mills, Erica Visintin, Olina Efthymiadou, David Taylor for their valuable input in earlier versions of the paper and two anonymous referees for helpful comments and suggestions. We are indebted for the input and insights received from country respondents to our survey.  This paper was developed in the context of the LSE Health - Medical Technology Research Group Pharmaceutical Regulation programme. Finally, we thank Pfizer Ltd. for financial support through an unrestricted educational grant. All outstanding errors remain our own.\nBackground\nExternal reference pricing (ERP), also known as external price referencing or international price comparison/ benchmarking, is a commonly used pricing policy with high global research interest. Officially defined as “the practice of using drug prices in several countries to derive a benchmark or reference price for the purposes of setting or negotiating prices in countries” [1-3], the primary aim is the control of in-patent drug prices [4] via the containment of pharmaceutical prices and expenditure [5]. The widespread use of ERP is generally a result of government cost control requirements with authorities using prices from other settings to evaluate the fairness or appropriateness of the actual price related to comparative cases [6]. The actual process of ERP implementation varies significantly between countries [7]. The size of the country reference basket used, ","cbCaieUM4VpRBtbz","https://ap.wps.com/l/cbCaieUM4VpRBtbz","docx",52506,20,"English","# Abstract\n## Background\n## Methods\n## Findings\n## Conclusion\n## Key words","[{\"question\":\"What is external reference pricing (ERP) and what is its main purpose?\",\"answer\":\"ERP uses drug prices from other countries as benchmarks to set or negotiate domestic prices. Its primary aim is to control in-patent drug prices by containing pharmaceutical prices and expenditure.\"},{\"question\":\"How was ERP implementation assessed in the study?\",\"answer\":\"A systematic literature review identified ERP characteristics across 29 countries. Surveys of key stakeholders supplemented the review when information was outdated or limited, and results were compared against 14 best-practice principles.\"},{\"question\":\"What did the study find about ERP implementation across countries?\",\"answer\":\"The study found significant heterogeneity in how ERP is implemented, including differences in basket size, pricing calculations, and the frequency of price revisions. Some countries aligned more closely with best practices than others.\"},{\"question\":\"What policy impacts result from the observed heterogeneity in ERP?\",\"answer\":\"Heterogeneity has implications such as globally declining pharmaceutical prices, launch delays in lower-income countries, weaker incentives to continue R\\u0026D, and reduced access to medicines. The study suggests that benefits require sustainable, transparent, simple, and stable systems supported by key guidelines.\"}]","External Reference Pricing Implementation - Does it Matter for Public Policy? | DOCX",1788325640,7]