The goal of this research is to understand the extent to which payers around the world are using discounted or net prices for international reference pricing (IRP) purposes as an alternative to list, manufacturing or wholesale prices. The research also examines what sources are being used to obtain these discounted prices. MethOds: Primary research was conducted with payers in 45 countries to establish the methodology of IRP in those countries. Specific questions were asked around both the current and potential future use of different types of prices for IRP. This was supplemented with secondary search and literature reviews of legislation and healthcare sources related to IRP to understand mechanisms of IRP. Results: Overall, it was shown that 8 countries used some form of discounted prices for IRP purposes, and that the number of countries is increasing. In addition, one country (Bulgaria), which previously had a requirement to reference discounted prices for
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