Prices and Affordability of Essential Medicines in 72 Low-, Middle-, and High-Income Markets

Abstract

Importance: Little is known about how the prices and affordability of medicines included on the World Health Organization's Model List of Essential Medicines vary across the globe.

Objective: To compare the list prices and affordability of essential medicines across high-, middle-, and low-income markets.

Design and setting: This cross-sectional study examined data from 2022 on list prices and volumes of 549 essential medicines in 72 high-, middle-, and low-income markets (covering 87 countries). These data were obtained from IQVIA. The statistical analyses were performed between August 2024 and March 2025.

Main outcomes and measures: Laspeyres price indices were used to compare average drug prices across countries, both in nominal and purchasing power parity-adjusted terms. The affordability of 8 essential medicines, used to treat major causes of death and disability globally, was assessed by calculating how many days of minimum wage would be required to pay for 1 month of treatment.

Results: The availability of essential medicines ranged from 225 (41%) in Kuwait to 438 (80%) in Germany (base country). After accounting for purchasing power parities, prices of essential medicines in Lebanon were, on average, 18.1% of those in Germany (Lebanon price index, 18.1 vs Germany price index, 100), while average prices in the US were 3.0 times higher than in Germany (US price index, 298.2). A positive association was observed between countries' gross domestic product per capita (expressed in logarithmic terms) and nominal drug prices (R = 0.30; P = .01), indicating that richer countries generally had higher drug prices. However, when adjusting for the purchasing power of different currencies, an inverse association was observed (R = -0.35; P = .003), suggesting that richer countries had lower real prices. Drug affordability, as measured by the number of days' minimum wage needed to purchase a month's treatment, varied widely, with median affordability highest in Europe and the Western Pacific, and lowest in Africa and Southeast Asia.

Conclusions and relevance: The results of this cross-sectional analysis showed significant variation in the prices and affordability of 549 essential medicines across 72 markets in 2022. Strategies to promote equitable drug prices and improve drug affordability are urgently needed.

Figure 1.. Average Prices of Essential Medicines in 87 Low-, Middle-, and High-Income Countries in 2022, With Countries Grouped by Tercile

The indices were calculated based on purchasing power parity–adjusted prices. Data were available for 69 individual countries, plus Hong Kong. Data for an additional 6 countries were aggregated as Central America, and data for 12 countries were aggregated as West Africa. Thus, the sample consisted of 72 markets, covering 87 countries (69 individual countries and 2 regions of 18 countries) plus the special administrative region of Hong Kong.

Figure 2.. Association of Gross Domestic Product (GDP) Per Capita With Average Drug Prices, 2022

Figure 3.. Breakdown of Brand-Name, Generic, and Over-the-Counter Drugs in Each Market by Value and Volume, 2022

Data for 12 countries were aggregated as West Africa, and data for 6 countries were aggregated as Central America. UAE indicates United Arab Emirates.