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Italy and Spain: pricing models for vaccines

In countries like Italy and Spain, once a vaccine has been approved for reimbursement, the national immunization technical advisory group (NITAG) or health technology assessment (HTA) agency negotiates with the manufacturer a national reimbursed price for the vaccine. This price then becomes publicly available and forms a price ceiling for future procurements negotiations.

However, while vaccines are approved approval is done on a national level in these markets, budgets are controlled on a subnational level by the regions. Therefore, vaccine manufacturers need to engage in procurement negotiations with these subregional entities, such as the 21 Regional Health Authorities in Italy or the 19 Autonomous Communities in Spain, which are responsible for the funding of immunization programs.

The separate regions could conduct individual procurement negotiations that result in confidential price arrangements; alternatively, the regions may opt into a centralized purchase process where they could potentially benefit from volume-based discounts. Tenders could also be organized in cases where multiple vaccines from the same class are available.

Germany: pricing models for vaccines

In Germany, a reference price for a given vaccine is determined on the basis of price per dose, any volume-based discounts, and reimbursement rates applied to the same product in four European countries with a similar GDP to Germany. The tendering process is not used in Germany.

UK: pricing models for vaccines

In the UK, manufacturers have to negotiate a cost-effective vaccine price that will allow them to meet the £20,000 per quality-adjusted life-year (QALY) threshold that is determined by the Joint Committee on Vaccination and Immunisation (JCVI). Tenders can be issued by the Department of Health to procure a supply of the vaccine.

Tendered prices are generally commercially confidential.

US: pricing models for vaccines

In the US, once a vaccine candidate has been recommended by the Centers for Disease Control and PreventionCDC, public and private healthcare providers engage in procurement negotiations with the manufacturer. Price arrangements normally reflect volume-based discounts and rebates. As result, the price of a given vaccine product may vary across different healthcare providers.

Read the next update in this series: Evaluation of vaccines: guidance on evidence and modelling requirements