Why Sweden brand drugs are cheaper
It’s cheaper because Sweden 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.
TLV value-based pricing
How it works
TLV (the Dental and Pharmaceutical Benefits Agency) decides if a drug is reimbursed, at what price, using cost-effectiveness. Regions then buy. Hospital drugs sit inside the county budget, not a 340B outpatient spread.
Why it holds
No reimbursement, no volume. Sweden is small and still about 24¢ on US brands (RAND: US 4.18×). A cancer year does not mint a hospital-outpatient markup on the vial. The chair is not the product.
The invoices
See RAND drugs. 30-day list prices: CMS 2023, Inflation Reduction Act round 1.
Twenty brands — US sticker vs Sweden
Ranked by the US number. 30-day list is CMS 2023 (Inflation Reduction Act round 1). Infusion doses are our hospital commercial bill. Sweden 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×.