Comment on ‘Cost differences between psoriasis biologics: implications for the Irish High Tech Scheme’

Cost comparisons of psoriasis biologics rely on list prices, but confidential rebates can substantially alter real costs—often hidden even from prescribers. Ireland's Framework Agreement mandates a transparent 37% price cut plus 12.5% rebate once a biosimilar enters the market, but deeper discounts for Best Value Biologics stay confidential. European tendering data show actual discounts of 80–90% off list price, meaning cost-minimisation analyses using list prices alone risk misleading clinicians. This letter proposes an approach similar to that in Scotland or Denmark - sharing relative net-cost rankings with prescribers without disclosing confidential absolute prices.