Overview

This discussion paper presents an overview of three pricing approaches that might facilitate affordable access to medicines for achieving universal health coverage. This draft is informed by the discussions from one of the two working groups set up in preparation for the Fair Pricing Forum 20210F. Three broad topics were discussed:

1. Cross-border collaborative initiatives to bring about more affordable pricing of medicines;
2. price and value of health products in the context of public health; and
3. regulating excessive pricing and returns along the supply and distribution chain.

In considering these topics, the working group considered health systems’ ability to pay and the ultimate goal of achieving universal coverage in line with Sustainable Development Goals Target 3.81F and Target 3.b2F. Several principles were repeatedly emphasized during the working group deliberations, including being evidence-informed, transparent, solution driven, operationally sound, and focusing on public health needs. In particular, consideration for the need to achieve price and pricing transparency has been a recurring theme across all the topics discussed. The working group also referred frequently to World Health Assembly resolution WHA72(8) Improving the transparency of markets for medicines, vaccines, and other health products, including transparency of price and funding across the value chain.

Across all topics, some fundamental questions at the core of the problems were raised. For example, how to assess affordability and excessive pricing; whether fair pricing could be achieved without transparency of price and costs from the supply side; whether fair pricing could mean that in the spirit of solidarity, higher income countries should pay higher prices than lower income countries; and whether States should play a greater and collective role in ensuring fairness in the pricing of and access to vaccines and medicines.

Several limitations should be noted from the outset. This paper, in its brevity, only intends to describe the main issues for discussion. Any proposed approaches presented are only preliminary drafts intended for stimulating discussions during the Fair Pricing Forum 2021. The purpose is to advance the discourse and identify potential solutions and further areas of work. The contents are non-comprehensive work-in-progress. All views in this paper reflect a snapshot of the discussions took place in the Working Group. These views do not necessarily represent the World Health Organization’s position or policy.