A 12-sheet pricing architecture built market by market: price ladder, international reference-price basket, value-based ICER, gross-to-net waterfall, launch sequencing, and revenue scenarios — not a single number, a re-runnable model.
Three NICE technology appraisals (TA606, TA738, TA1101) each carry a confidential Patient Access Scheme, so garadacimab's published £20,625 per-pen price is the only fully transparent figure in the class, and two MHRA-licensed agents still have no NICE-confirmed net price.
NPHC's negotiated Zolgensma price runs $1.5-1.8M against $2.125M US list, but the real mechanism is a 24-month motor-milestone rebate, the same structure now anchoring risdiplam and nusinersen pricing across the Gulf.
Lanadelumab tenders at SAR 300,000-400,000 a year, but NPHC has no routine formulary price at all; access runs through an individual-case bar only 30-40% of submissions clear, while private VHI approves at a materially lower documentation threshold.
Iptacopan's substantial-benefit finding gave Germany real negotiating leverage over Novartis. Six months on, no negotiated net price has surfaced in the Lauer-Taxe — the pricing signal this model is built to catch before a launch-sequencing decision locks in the wrong assumption.
NICE has cleared every modern PNH anti-complement therapy, from ravulizumab to crovalimab, through the standard £20,000-30,000 Technology Appraisal route rather than the more generous Highly Specialised Technologies threshold, each via a confidential patient access scheme.
Fabrazyme's orphan-drug exclusion under the IRA shields it from Medicare price negotiation entirely, and no rebate or net-price figure is disclosed anywhere in the primary record for any Fabry therapy. The orphan exclusion, not a discount ladder, is what a Fabry pricing strategy has to be built around.
Wegovy lists at roughly $1,349 a month, but CMS pays $274 for a 30-day semaglutide supply starting 2027, a 71% cut that applies to Ozempic, Rybelsus, and Wegovy alike. Tirzepatide sits outside the negotiation entirely, for now.
Two IRA negotiation cycles have now cut across the T2D formulary: Januvia down 79% to $113, Jardiance down 66% to $197, Farxiga down 68% to $178 from January 2026, and semaglutide down 71% to $274 with Janumet and Tradjenta added for 2027.
Stelara's negotiated price falls to $4,695 from a $13,836 list, a 66% cut, effective January 2026, the same month ustekinumab biosimilars begin launching. Two separate pricing shocks land on one legacy biologic at once.
Three IV enzyme replacement brands run ~$300,000/year with no generic rival, so preferred-ERT designation is the real pricing lever. Eliglustat's CYP2D6 gate and generic miglustat's trial-first rule complete the picture.
Iptacopan's ~$550,000 annual WAC sits roughly 71% above ICER's own $156,000-157,000 value-based benchmark, yet the orphan-drug exclusion keeps anti-C5 incumbents priced outside IRA's reach entirely, the two forces any new US PNH entrant must price against.
All five FDA-approved IgAN therapies clear the same prior-authorization gate, biopsy-confirmed diagnosis, UPCR 0.8-1.5 g/g, eGFR 30 or higher, RAS-blockade step-through, rather than a negotiated rebate table. No formal net-price data exists because access here runs on step-therapy criteria, not payer negotiation.
Sutimlimab costs $259,000-$302,000 per patient per year, and a peer-reviewed analysis puts its ICER at $2.34M/QALY, standard of care favored in all 10,000 probabilistic-sensitivity iterations. The value gap, not a rival drug, sets the pricing discipline.
IgA nephropathy sits outside NPHC's genetic/orphan disease scope entirely, so there is no GCC formulary price to model. Budesonide clears case-by-case at SAR 80,000-120,000/year through hospital committees or private insurance; sparsentan is not yet tender-priced at all.
HAS splits PNH into two tracks: ravulizumab holds SMR important and first-line, priced at €14,988.66 per 1100mg vial. Iptacopan cleared only ASMR III, restricted to second-line, its €29,590.96 box price negotiated against a manufacturer-declared population of 270 patients.
NICE's accepted 20-35% PAS discount off budesonide's WAC sets the pricing floor sparsentan already clears too, against a £140-180M NHS budget ceiling once the ACEi/ARB gate narrows eligibility to 3,000-5,000 patients.
Fintepla's weight-based list price runs roughly 3x Epidiolex, and payers work that gap through step-edit design layered on Part D pharmacy-benefit routing. No generic cannabidiol reaches the US market before the late 2030s.
Agalsidase beta runs an estimated £150-250K per patient per year against migalastat's £80-120K, a £70-130K annual switch saving NICE has already quantified but the NHS has not captured at scale, with pegunigalsidase's TA915 commercial arrangement now setting a third price point.
Both NHS-commissioned Dravet therapies cleared NICE's standard £20,000-30,000/QALY bar, not the ultra-rare HSS threshold, so a new entrant is held to the same cost-effectiveness bar the incumbents already cleared. Total NHS Dravet spend still runs a modest £9-16M.
NPHC pays roughly SAR 1.2-2.4M per patient per year for enzyme replacement against SAR 400-600K for migalastat, a 72% differential that gives NPHC a direct financial incentive to switch eligible patients, capped almost entirely by a single-laboratory diagnostic bottleneck rather than by price.
GCC Dravet pricing is an import-cost economics problem, not a rebate negotiation: cannabidiol's Schedule-1-equivalent narcotics classification adds USD 10-15K in compassionate-programme cost plus SAR 5-8K in import logistics, while stiripentol's non-narcotic status keeps it at SAR 30-50K through standard hospital import.
Tafamidis prices 12-17x above ICER's fair-value benchmark, yet the orphan-drug exclusion keeps it out of IRA negotiation. Acoramidis and pending generics, not Medicare, now set net price.
Casgevy and Lyfgenia list at $2.2M and $3.1M, but CMS's Cell and Gene Therapy Access Model, Medicaid concentration, and a $1.5-1.9M ICER ceiling decide the realized net, not the sticker price.
NICE's TA1121 cost-minimisation rule directs clinicians to whichever ATTR-CM stabiliser costs less. That rule, not the QALY threshold alone, now sets a new entrant's UK price ceiling.
GCC anti-C5 tender pricing already runs 40-60% of US WAC, anchored to whichever EU comparator prices lowest, then compounded with a further 10-20% negotiation discount. Iptacopan has to clear the same cascade, still 12-24 months from SFDA registration.
NICE rejected crizanlizumab at £733K-1.1M per QALY even with a PAS discount. Casgevy cleared only via a 10-year annuity at £165K/year, and any new non-gene agent must land near £15-25K/year to clear that same ceiling.
Pompe ERT WAC runs near $400,000 a year, and the Pombiliti + Opfolda regimen splits across Medicare Part B and Part D. Zero ICER reviews exist today, with one expected in 2025 and a 12-month J-code lead time for any new entrant.
ICER priced efgartigimod's value at $18,300-28,400 a year, under half its ~$418,400 assumed launch price, and that gap is hardening into a three-tier step-edit staircase across US commercial and Part B plans.
Ibrance's Medicare-negotiated price takes effect a full year before Kisqali's and Verzenio's. Three clinically equivalent drugs, staggered IRA negotiation cycles, means Pfizer sets the reference point Novartis and Lilly then have to negotiate against.
GCC tafamidis pricing is not one number. Private-import pricing near SAR 820,000-850,000/year describes the pre-registration state; post-registration tender pricing near SAR 70,000-90,000 describes what follows.
NHS-commissioned alglucosidase alfa runs £200,000-350,000 per patient a year post-PAS. Avalglucosidase alfa's NICE TA821 recommendation carries a 20-30% WAC premium and a switch-population budget impact of just £2-4M a year.
At 200,000-250,000 GCC patients, US or UK list pricing is commercially impossible. NPHC's own exceptional-access threshold caps a novel agent near SAR 8,000-20,000/year, a fraction of a $2.2M gene-therapy WAC.
No UK gMG biologic has ever cleared NICE at any price. Eculizumab's manufacturer withdrew before submitting an ICER, and efgartigimod's June 2025 rejection means a future entrant's price ladder starts from zero precedent, not a benchmark.
Zolgensma's $2.125M sticker price obscures the real US SMA pricing lever: a 10-state Medicaid outcomes-based annuity paying $212,500 a year for ten years, set against chronic Spinraza and Evrysdi costs and a Part B/Part D routing split that changes patient cost by drug.
NPHC's annual Pompe ERT budget runs SAR 100-160M across 80-120 patients, at SAR 800K-1.2M for alglucosidase versus SAR 1.2-1.8M for avalglucosidase. A new entrant should target SAR 2.0-2.5M a year, with switch approvals clearing at only 40-60%.
GCC gMG has no single price. Efgartigimod costs SAR 300,000-600,000/yr through private VHI, a different figure through hospital pharmacy committees, and a third through NPHC exceptional access, with a unified formulary price still 12-18 months out.
Lanadelumab lists near $450,000 a year against berotralstat's roughly $95,000, and ICER's 2021 fair-value benchmark for berotralstat lands almost exactly on that list price. The three 2025 entrants carry no ICER anchor of their own.
NICE rejected Zolgensma in 2021 on cost per QALY, then reversed in 2023 through its Long-Term Value Framework. That framework, not the PAS discount, is the real UK SMA pricing lever, and it sets an estimated £1.2-1.6M net cost against a £4.5-7.5M lifetime chronic-therapy alternative.
An editable 12-sheet Excel pricing model and a PDF methodology brief, with a 45-minute analyst call included. No PowerPoint deck — this deliverable is built to be worked in directly, not presented from.
Every reference price, rebate mechanism, and ICER input is cited to a primary regulatory or HTA source — no price point is carried from model memory.
Yes. You set the market basket, comparator class, and WTP threshold; the model is built to your scope and delivered editable.