One molecule, two systems, the same patent expiry. France set the price and held it. England let competition set it. Scroll to see which country ended up paying more.
France holds almost perfectly flat. England falls off a cliff in mid 2023 when generic apixaban enters and competition sets the price.
By the end, an English tablet costs 5% of what it did. A French box costs 94%.
The CEPS revision took the reimbursement base from €62.88 to €59.16, a fall of 5.9%. That is the only move in the entire series.
A negotiated price is a decision, and decisions are infrequent. This is what a price looks like when nobody is competing on it.
France nearly doubled, from 720,000 to 1.42 million boxes a month. England grew 45% in items over its shorter window.
Same drug, same clinical direction of travel. Nothing here explains what happens next.
France pays 86% more than it did in 2021, €45m a month rising to €84m. England pays 93% less, £27.8m falling to £2.1m, from a peak of £35.2m.
Held price, rising bill. Collapsed price, collapsing bill. The country that controlled the price is the one that lost control of the spend.
France's price discipline was real and it did almost nothing to the total, because volume did the work instead. England never negotiated the price down at all. Competition did it, and far harder than any negotiator would have dared ask.
If your budget impact model moves price and holds volume, it is answering the wrong question.
Every figure above comes from the reimbursement records each country publishes: Medic'AM in France and the English Prescribing Dataset in England, read at molecule level in our data lake. No survey, no panel, no estimate.
Read the full analysis Next story: One molecule, three prices