The EFPN study, Price Transparency of Cancer Medicines, compares the 2022 listed prices, average actual prices and discounts for 15 cancer drugs across 23 hospitals in the Netherlands, France, Germany, Hungary, Serbia, and four other European countries [1]. While official list of reference prices exist, the real prices hospitals pay depend more on confidential discounts. As a result, prices for the same treatment vary widely across Europe.
The study found striking differences in prices across Europe. For example, ribociclib, a common breast cancer treatment, showed an average price difference of 183% between hospitals. In Germany alone, the price varied by up to €3.791 (126%) between hospitals participating in the research.
Lenalidomide, a medicine used to treat myeloma, showed the biggest relative difference, with the average actual price varying by 677% between hospitals.
Abiratone, a prostate cancer medicine, costs €300 in Germany but €1,435 in Southern Europe. Even within the same country or region, prices differed substantially: prices for this specific drug varied by as much as 239% (€716) between hospitals in Germany, while in Southern Europe, the difference reached 166% (€2,375).
On average, hospitals in Hungary paid almost three times more for a medication used to treat breast, colorectal, and gastric cancers (capecitabine) than those in Germany. Additionally, Hungary saw the highest cost for the chemotherapy drug gemcitabine, used in the treatment of lung and bladder cancer, paying nearly three times more than countries in Southern Europe and Germany.
The highest average hospital product prices were observed in France, at only 23% below the reference prices of all countries included in the study. In comparison, average prices in Germany and the Netherlands were 29% and 32% below their respective reference prices.
However, because reference prices vary between countries and function as starting points for negotiation, a larger percentage discount does not automatically translate into a lower actual price.
Crucially, the study also challenges the widespread assumption that cancer drugs are always priced higher in countries with stronger economies. In fact, countries with lower spending power often face higher hospital prices for cancer medicines, despite their more limited resources.
In Hungary, for example, hospitals negotiated average price discount of 23%. In comparison, Southern European countries enjoyed discounts of 38% while hospitals in the Netherlands negotiated discounts of 33%.
This illustrates that countries with lower spending power do not systematically receive lower price offers, even though the official reference prices for these countries are lower. In other words, official reference prices often do not reflect the real prices hospitals pay, raising concerns about how countries use these reference prices in their budgeting decisions and how external reference pricing is used among countries.
Price secrecy is a key driver of these imbalances, and it is leaving hospitals in the dark. Because outcomes of price negotiations are confidential, hospitals cannot compare what they are paying compared to others, effectively reducing their bargaining power. The same is true for negotiations on national level.
The EFPN study shows that many hospitals believed they were securing good deals without any meaningful access to benchmark information for comparison. In reality, at least half of hospitals misjudged their performance, with some paying 22% above the national average price while assuming they were paying less.
In many cases, hospitals also do not know the final net price of medicines, as multiple layers of negotiations further obscure costs. Depending on the country and product, prices can be negotiated at national, regional, insurer or hospital level, and sometimes through purchasing groups. This creates multiple prices for the same medicine within a country. Because of confidentiality agreements, comparisons are almost impossible. In the end, only the manufacturer knows the true net price.
“Our study is one of few providing information on discounts and actual prices for 15 cancer medicines, revealing large price variations between and within countries”, said Professor Wim van Harten, Principal Investigator of the European Fair Pricing Network (EFPN).
“With cancer drug costs making up a growing share of hospital budgets, these unexplained price differences translate into millions of euros in potentially avoidable public spending — raising urgent questions about the long-term sustainability of European healthcare systems”, he concluded.
The EFPN study shows how confidential pricing practices affect hospitals – and cancer patients – differently across Europe. To remedy the resulting disparities between European countries, a coordinated EU-wide response to improve transparency of drug prices is urgently needed.
The study is released at a time when the United States has introduced a “most‑favoured‑nation” (MFN) drug pricing policy. This policy requires U.S. prices to match the lowest prices paid in other wealthy countries. In response, pharmaceutical companies have urged policymakers to increase EU list prices [2]. However, the EFPN findings raise serious doubts about whether such international price comparisons reflect real-word pricing.
As EU governments and members of the European Parliament are negotiating the Critical Medicines Act, the European Fair Pricing Network is calling for a fundamental EU-wide system change that allows for better cooperation and puts transparency and equity first.
“Confidential pricing practices are creating unacceptable inequalities across Europe, with some hospitals paying far more than others for the exact same life-saving cancer medicines,” said Wolfgang Fecke, Executive Director at the Association of European Cancer Leagues (ECL).
“Transparency in drug pricing negotiations must become the rule, not the exception. We call on the European Parliament and Council of the EU to use the Critical Medicines Act to end secrecy in price negotiations and tackle disparities between countries by making the joint procurement of cancer drugs a reality. In addition, we urgently need an EU-wide price observatory that equip national authorities and hospitals with the tools to negotiate fairer and lower prices.”
- The study features analyses from the Netherlands, France, Germany, Hungary, Serbia, a Baltic state, two southern European countries and a Northern European country. Certain countries were grouped together to ensure anonymisation.
- See for example: https://www.ft.com/content/de921b3c-988c-4d60-aca1-def85c70d299
- Ivonne Leenen, Communications Officer at the Association of European Cancer Leagues (ECL): ivonne@cancer.eu
The European Fair Pricing Network (EFPN) brings together national cancer societies, research institutes and European cancer organisations to promote fair pricing and better access to innovative cancer medicines. EFPN members include the Association of European Cancer Leagues (ECL), the Dutch Cancer Society, the Netherlands Cancer Institute, the Organisation of European Cancer Institutes, the Swiss Cancer League, Stand Up To Cancer Flanders, the Norwegian Cancer Society, the Cyprus Association of Cancer Patients and Friends, and the Nordic Cancer Union.