Why Japan brand drugs are cheaper
It’s cheaper because Japan 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.
Chuikyo / NHI fee schedule
How it works
The Central Social Insurance Medical Council (Chuikyo) sets NHI drug prices. The list is public. Prices are cut every other year — sometimes faster — so a brand does not sit at launch forever. DPC hospitals cannot turn the vial into a 340B-to-commercial spread. There is no job-plan PBM taking US list.
Why it holds
France and Japan are the cheapest G7 brand markets in RAND. US brands 4.64× Japan — Japan is about 22¢. Presentation overlap with the US is the smallest in G7 (17% of Japanese volume); RAND’s active-ingredient check still found Japan cheap. They infuse. They stay in hospital for weeks. They do not pay US list so a manufacturer can recoup R&D a second time.
The invoices
See RAND drugs. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.
Twenty brands — US sticker vs Japan
Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. Japan 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×.