What Strategies Can Payers Use to Negotiate Medicine Prices Globally? Insights and Lessons for Low-Income Countries from a Scoping Review

OBJECTIVES: No comprehensive global review has synthesized mechanisms, strengths, limitations, and implementation challenges of pharmaceutical pricing policies. This scoping review aimed to examine global pharmaceutical pricing policies and generate policy-relevant insights, particularly for low- and middle-income countries (LMICs). METHODS: Electronic searches were conducted in Medline, CINAHL, EconLit, and Embase using predefined inclusion criteria. Gray literature was identified through government publications and World Health Organization reports, and reference lists of relevant studies were screened. The review followed the Joanna Briggs Institute scoping review framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. RESULTS: Searches conducted up to May 2024 and updated in February 2026 identified 88 eligible studies. Reference pricing was the most commonly reported strategy, used in 85% of identified countries, offering simplicity and transparency through price benchmarking. Value-based pricing was widely adopted in high-income countries, aligning prices with health outcomes but requiring strong health technology assessment infrastructure. Managed entry agreements were reported in 56% of countries and were used to improve access to new medicines while mitigating financial risk. Indication-specific pricing was implemented in 9 countries but faced operational challenges. Compulsory licensing in several LMICs improved access to essential medicines at lower cost, although concerns regarding impacts on pharmaceutical innovation were noted. Most countries combined multiple pricing approaches to balance affordability, access, and innovation. CONCLUSIONS: Although value-based pricing and managed entry agreements are common in high-income settings, simpler approaches such as reference pricing and compulsory licensing may be more feasible in LMICs. Context-specific strategies are needed to balance access, affordability, and sustainability.