Why Australia brand drugs are cheaper
It’s cheaper because Australia sets one price for the drug. Every hospital and pharmacy pays that (or a cap under it). In the US, each insurer and PBM bargains a rebate off a high list, and the sticker stays high.
PBS — bargain the whole list as a country
How it works
The Pharmaceutical Benefits Scheme lists a drug only after PBAC says it is cost-effective. Then the Commonwealth bargains the price. Take-it-or-leave-it. Private extras do not reset that floor.
Why it holds
Australia is 27 million people and still about 20¢ on US brands (RAND: US 5.00×). Manufacturers list on the PBS because that is how you sell in Australia. They still get Keytruda on the PBS. They do not get US list.
The invoices
See RAND drugs. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.
Twenty brands — US sticker vs Australia
Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. Australia column is that US sticker × this country’s RAND brand index. Gross list, not rebates. Even after a US rebate haircut, RAND says brands stay more than 3×.