Apixaban, the anticoagulant on 25 million prescriptions a year across England, the US and Australia. Scroll to watch what each system paid when its patent died.
Three patent-protected prices, three currencies, one flat line each: England £0.89 a tablet, the US $8.97, Australia $93.50 a script. Indexed to 100, the systems are indistinguishable. The interesting part is what happens next.
Generics entered and the market did the rest: £0.89 to 4.4p in eighteen months, a 95% collapse, while volume rose 17%.
The NHS now buys the same tablet for a twentieth of what it paid in June 2023, roughly £350m a year released from one molecule.
Patent settlements kept US generics off the market. With no competition, the acquisition price rose every single year, $7.98 to $9.70, a fifth higher while England's fell 95%.
By 2025 a US pharmacy paid ~170× England's price for the same pill.
Not from a generic. Apixaban was in Medicare's first negotiation cohort, and the moment the negotiated price took effect, the price dropped 43% overnight, the only downward move in thirteen years of data.
Competition never arrived; legislation did.
No cliff, no drama: two statutory price-disclosure cuts, right on schedule: April 2023, then a 25% step in August 2024, with gentle indexation drift in between.
Erosion by timetable: −16% in five years, exactly as the mechanism intends.
England 5 · US 62 · Australia 84. That is where the same June-2023 pound, dollar and PBS fee stand today.
If your forecast assumes one global erosion curve after loss of exclusivity, it is wrong in at least two of your three biggest markets.
Every line above is drawn from national dispensing and pricing data: 748 million English prescription rows, the CMS NADAC file, the Australian PBS, processed in our own data lake. The same engine prices loss-of-exclusivity scenarios in client forecasts.
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