It’s cheaper because France 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.
How it works
HAS judges added benefit. Then CEPS (Comité économique des produits de santé) negotiates the price: international reference, volume clawbacks, a contract. Assurance maladie pays that price. The hospital does not keep a 340B spread on the vial.
Why it holds
France is a launch market you cannot skip, and CEPS knows it. RAND: US brands 4.45× France — France is about 22¢, among the cheapest on these tabs. They infuse in hospital too. The chair is not a second price.
The invoices
SKUUnited StatesFrance
Brand originators on the US dollarsourced$1.0022¢
All drugs on the US dollarsourced$1.0031¢
Specialty year at the brand indexmodeled$150,000~$34,000
See RAND drugs. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.
Twenty brands — US sticker vs France
Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. France 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×.
DrugUnited StatesFranceOn the US $
Keytruda (pembrolizumab)hospital dosemodeled$16,800$3,77522¢
Opdivo (nivolumab)hospital dosemodeled$15,000$3,37122¢
Alteplase (tPA) stroke dosehospital kitmodeled$15,000$3,37122¢
Imbruvica (ibrutinib)30-day listsourced$14,934$3,35622¢
Stelara (ustekinumab)30-day listsourced$13,836$3,10922¢
Herceptin-class (trastuzumab)hospital dosemodeled$9,200$2,06722¢
Neulasta-class (pegfilgrastim)hospital dosemodeled$8,900$2,00022¢
Avastin-class (bevacizumab)hospital dosemodeled$8,100$1,82022¢
Enbrel (etanercept)30-day listsourced$7,106$1,59722¢
Rituximab biosimilarhospital dosemodeled$6,800$1,52822¢
Remdesivir coursehospital coursemodeled$4,200$94422¢
Humira-class (adalimumab) clinicclinic syringemodeled$2,400$53922¢
Ozempic (semaglutide)30-day listmodeled$969$21822¢
Entresto (sacubitril/valsartan)30-day listsourced$628$14122¢
Jardiance (empagliflozin)30-day listsourced$573$12923¢
Farxiga (dapagliflozin)30-day listsourced$556$12522¢
Januvia (sitagliptin)30-day listsourced$527$11822¢
Eliquis (apixaban)30-day listsourced$521$11722¢
Xarelto (rivaroxaban)30-day listsourced$517$11622¢
NovoLog / Fiasp (insulin)30-day listsourced$495$11122¢