Why Germany brand drugs are cheaper
It’s cheaper because Germany 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.
AMNOG — prove it, then the price falls
How it works
The manufacturer sets a launch price for about six months. Then IQWiG/G-BA judge added benefit. If the extra benefit is not there, the price is referenced to the class (AMNOG). Statutory funds pay that. No 340B outpatient markup on the vial.
Why it holds
The threat is real: no added benefit, no premium. Germany is a launch market manufacturers cannot skip, so they take the AMNOG price. RAND: US brands 3.87× Germany — Germany is about 26¢. The 5% still get the oncology year.
The invoices
See RAND drugs. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.
Twenty brands — US sticker vs Germany
Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. Germany 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×.