Prices and affordability of essential medicines in 72 low-, middle-, and high-income markets in 2022

Importance. Little is known about how the prices and affordability of medicines included on the World Health Organization’s Model List of Essential Medicines vary across the globe. Objective. To compare the list prices and affordability of essential medicines across high-, middle-, and low-income markets. Design and Setting. This cross-sectional study examined data from 2022 on list prices and volumes of 549 essential medicines in 72 high-, middle-, and low-income markets (covering 87 countries); these data were obtained from IQVIA. Main Outcomes and Measures. Laspeyres price indices were used to compare average drug prices across countries, both in nominal and purchasing-power-adjusted terms. The affordability of eight essential medicines, used to treat major causes of death and disability globally, was assessed by calculating how many days of minimum wage would be required to pay for one month of treatment. Results. Availability of essential medicines ranged from 41% (225/549) in Kuwait to 80% (438/549) in Germany. There were large differences in list prices after accounting for purchasing power parities. Prices of essential medicines in Lebanon were on average about 18% of those in Germany (the base country), while average prices in the US were about 3 times higher than in Germany. We observed a positive relationship between country per-capita income levels (expressed in logarithmic terms) and nominal drug prices (R=0.30 and P=0.02), meaning that richer countries, on average, had higher drug prices. However, when adjusting for the purchasing power of different currencies, we found the inverse relationship (R=-0.35 and P=0.02), suggesting that richer countries had lower real prices. Drug affordability, as measured by the days’ wage needed to purchase a month’s treatment, varied widely, with median affordability highest in Europe and the Western Pacific, and lowest in Africa and South-East Asia. Conclusions and Relevance. Strategies to promote equitable drug prices and improve drug affordability are urgently needed.