Pharmaceutical net price transparency across European markets: Insights from a multi-agent simulation model

: With pharmaceutical health policy striving for fair and sustainable pricing under increasing budgetary pressures, public stakeholders are more and more willing to be involved in transparent access decision-making related to novel medicines, considered by them to be a societal good. Full net price transparency (NPT) is believed by many to promote price competition and to increase equity by making pharmaceutical products accessible to all. Using agent-based simulations, we find that a full NPT system implemented across EU countries would not be viable. This while, acting as rational economic agents, a group of middle- and lower-income countries would not be willing to give up their confidential agreements with the pharmaceutical industry. Even partial NPT would delay access predominantly in middle- to lower-income countries. Hence, we conclude that implementing net price transparency across Europe would be challenging to reach from a political perspective. Especially in lower-income countries there would remain a plea to be left free to negotiate confidential discounts with drug manufacturers. This while, counterintuitively, in those countries NPT will be seen to be unjust while violating Ramsey pricing and distributive justice principles.