Comment on the implications of external price referencing of pharmaceuticals in Middle East countries

Expert Rev Pharmacoecon Outcomes Res. 2016;16(1):11-4. doi: 10.1586/14737167.2016.1136791. Epub 2016 Feb 2.


External Price Referencing (EPR) is frequently used by countries to control pharmaceutical prices but studies to substantiate its use in the Middle East (ME) is lacking. The paper by Kalo et al set-out to fill this lacuna through three objectives: i) to document the use of EPR in 7 ME countries, ii) to assess whether pharmaceutical EPR resulted in a narrow price corridor for patented pharmaceuticals, and iii) to analyse factors influencing pharmaceutical prices. This comment discusses why the paper fell short of achieving these objectives and over-stated the results. Despite a thought-provoking contribution, objective 1 presented few new insights on EPR mechanisms, objective 2 deployed an inappropriate research design, and the policy implications of objective 3 are voided given the choice of explanatory variables.

Keywords: Cross-national price comparison; Middle East countries; external reference pricing; pharmaceutical pricing; price corridor for pharmaceuticals.

Publication types

  • Letter
  • Comment

MeSH terms

  • Commerce / economics*
  • Drug Costs / statistics & numerical data*
  • Humans
  • Pharmaceutical Preparations / economics*


  • Pharmaceutical Preparations