In an article in the Journal of the Norwegian Medical Association, Østby and Solli from Pfizer claim that there are good reasons to keep drug prices confidential (1). They are of course free to put forward such a claim, but from reading their article it appears unclear why this is so. They indeed write that 'confidentiality provides enterprises with an opportunity to differentiate prices between countries with varying ability or willingness to pay', but this mainly appears to be an argument for why confidential prices are good for Pfizer. This allows them as well as other pharmaceutical companies to sell their drugs at the highest possible price in each country and thereby maximise their earnings.
Østby and Solli provide a reasonably accurate description of how the priority setting criteria are operationalised in the assessments made by the Decision Forum, but this does not amount to a valid argument as to why confidential prices are a good thing. The fact that previously there was more transparency regarding prices, but less regarding processes and criteria, is not an argument for why more transparency regarding processes and criteria should result in less transparency regarding prices. Nobody will disagree that priority decisions are not made on the basis of price alone. The high prices that pharmaceutical companies charge for their new drugs nevertheless make price a crucial factor for determining whether a drug is cost effective or not.
The assessment of Keytruda (pembroluzimab) for lung cancer (2) says: 'The Norwegian Medicines Agency finds that taking into account the degree of seriousness, clinically relevant effect and cost effectiveness, as well as uncertainty in the analyses, Keytruda does not meet the criteria for a recommendation for use, given the prevailing maximum AUP (the maximum sales price of the drug dispensed from pharmacies, author's note). If the tender price is used as the basis, the Norwegian Medicines Agency is of the opinion that Keytruda meets these criteria.' Without a discount, Keytruda does not meet the criteria, but with a discount it does. The size of the discount dictates the decision, as for most new drugs that are being assessed.
Confidential prices prevent health economists and other specialists from verifying the decisions.
Confidential prices prevent health economists and other specialists from verifying the decisions. Nor can decisions be appealed. Patients and next of kin receive no explanation for the rejection. Research on this topic is undermined, since the actual conditions for the decision are unavailable.