Incze, AndrásKaló, ZoltánEspín, JaimeKiss, ÉvaKessabi, SophiaGarrison, Louis P2023-05-032023-05-032022-04-061663-9812http://hdl.handle.net/10668/20702Background: External reference pricing (ERP) is used to set pharmaceutical prices to improve affordability, but its application may have negative consequences on patient access-thus, equity-across countries and on global innovation. With the United States contemplating ERP, negative effects could be magnified. Our aim: identify and quantify some major consequences of ERP. Research design, methods: Besides relying on databases and ERP modelling, we developed a heart failure case study. 4-step approach: 1) review ERP policies; 2) establish worldwide "price corridor"; 3) quantify patient access and health outcomes impact by ERP; 4) estimate ERP impact on innovation. Results: Our ERP referencing analysis highlights its perverse effects especially in lower-income countries. As counterstrategies to protect their revenues, manufacturers often implement tight list price corridors or launch avoidance/delays. Consequences include suboptimal patient access-hence, worse outcomes-illustrated by our case study: 500,000 + QALYs health loss. Additionally, the ensuing revenue reduction would likely cause innovation loss by one additional medicine that would have benefitted future patients. Conclusion: This research provides key insights on potential unintentional consequences of medicine price setting by ERP worldwide and under a new proposal for the United States. Our results can inform stakeholder discussions to improve patient access to innovative medicines globally.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/External Reference PricingPatient AccessPharmaceutical InnovationPrice RegulationU.S.Worldwideresearch article35462921open access10.3389/fphar.2022.815029PMC9019924https://www.frontiersin.org/articles/10.3389/fphar.2022.815029/pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9019924/pdf