Why Netherlands brand drugs are cheaper
It’s cheaper because Netherlands 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.
Preference policy + a cap
How it works
The authority can cap prices. Insurers then run preference policies: they designate a preferred generic or biosimilar and will not pay extra for the originator without a medical reason. Brands land at Dutch prices, not US list.
Why it holds
This is the cheapest brand tab on the board. RAND: US 5.89× Dutch brands — the Netherlands is about 17¢. It works because the preferred product gets the volume. Manufacturers still sell in the Netherlands. They do not get a US list as a consolation prize.
The invoices
See RAND drugs. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.
Twenty brands — US sticker vs Netherlands
Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. Netherlands 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×.