Vaccine Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 396

and Information Set (HEDIS), a tool used by most US health plans to measure phy-
sician performance.
Last not least, the new vaccine needs to be accepted by consumers. Making vac-
cination with a new vaccine mandatory might be seen as the most effective way to
speed up its consumer acceptance. This is what Merck attempted to achieve through
extensive lobbying when they launched Gardasil. However, faced with growing
criticism, they suspended their lobbying effort 6 months after launch (Rosenthal
2008 ). Schwartz ( 2010 ) recommends that vaccine mandates should be considered
only after a new vaccine is well established and widespread support exists, which
traditionally has taken at least 5 years.

13.4.5 Vaccine Pricing

Like for other pharmaceuticals (Frank 2001 ), for vaccines the “law of one price”
holds neither within nor across countries. Public buyers in the United States benefi t
from lower prices than private buyers, and even among private buyers there is
enormous variation in the prices paid by different physician practices for the same
vaccine (Freed et al. 2008b ).
Prices for the same vaccine can also vary greatly across countries. For example,
among seven high-income countries the launch price for Gardasil was highest in
Germany at $527, followed by $429 in Switzerland, $360 in the United States, $359
in Denmark, $335 in Canada, $315 in Australia, and lowest in New Zealand at $292
(Haas et al. 2009 ). Low- and middle-income countries procuring vaccines through
UNICEF/GAVI and PAHO only pay a fraction of the public sector US federal con-
tract price. For example, the UNICEF/GAVI prices per dose for four vaccines
ranged from 2 to 12 % of the US federal contract price (Nguyen et al. 2011 ).
Some of the price differences may be due to differences in costs. Different
contractual arrangements concerning logistics, product liability, returns policy,
payment, length of contract, and guaranteed volumes may indeed engender cost
differences.
Price differences can also represent price discrimination, also called differential
pricing or tiered pricing. Tiered pricing exploits differences in price elasticity result-
ing from differences in buyer power, willingness to pay, and ability to pay. The
lower US federal contract price compared to the private sector price and the lower
prices of practices participating in purchasing cooperatives purchase compared to
practices buying directly from manufacturers (Freed et al. 2008b ) refl ect mainly
differences in buyer power in the United States. Differences in public prices between
countries with similar high per capita income levels are probably rooted in differ-
ences of willingness to pay, which are refl ected in the cost-effectiveness criteria
applied in most European countries, whereas the differences between the UNICEF/
GAVI prices and the US federal contract prices refl ect mainly differences in the
ability to pay.