As you know, at No es Sano we’ve been working for years to promote greater transparency in the system for setting medicine prices. Knowing how much we pay for publicly funded treatments is a citizen’s right and a necessary condition for building a fairer and more sustainable healthcare system.
Today, we’re publishing a new report that takes an in-depth look at how the lack of transparency in net medicine prices—meaning the actual prices after discounts and confidential agreements—contributes to treatments being inaccessible for many people and placing an increasing burden on public budgets. This lack of information, far from being an exception, is the global norm and has particularly serious consequences in countries with less negotiating power.
The report includes evidence that debunks the argument that confidentiality protects lower-income countries. On the contrary, multiple cases have shown that prices paid in those countries are sometimes even higher than in wealthier economies—this was the case with medicines for cystic fibrosis and COVID-19 vaccines.
In Spain, as you may know if you’ve been following us, we’ve been pursuing legal action since 2019 to gain access to public information about the prices of high-impact medicines like Kymriah, Veklury, or Zolgensma. Although the Spanish Council for Transparency and Good Governance has ruled in our favor in several cases, pharmaceutical companies—and sometimes even the Ministry of Health—have appealed those decisions, arguing that such information must remain confidential.
In 2024, for the first time, the Ministry chose not to appeal a ruling requiring it to disclose the real price of remdesivir (Veklury). Although the legal case continues at the pharmaceutical industry’s initiative, this decision signals a potential shift in the institutional stance. Still, opacity persists: we recently requested access to the price and pricing criteria for the antiretroviral lenacapavir (Sulenca), and once again the Ministry denied access, citing confidentiality and the protection of commercial interests. This case adds to a long list of obstacles that highlight the urgent need for a transparency framework that doesn’t rely on constant litigation.
The legal, technical, and political work we are doing aims to open the door to deep, structural change. Because this isn’t just about numbers—it’s about challenging a system that allows prices to be set without objective criteria, without accountability, and without putting the public interest at the center. Opacity leaves us in the dark during key negotiations that directly impact the health of millions.
That’s why this report also proposes concrete steps forward: from conditioning public incentives on net price transparency, to ensuring that this information is included in all publicly funded contracts and agreements. We also highlight good practices from other countries that could inspire change here and across Europe.
Transparency should not depend on lengthy, costly legal processes. It must be an institutional obligation and a guarantee for the public. At No es Sano, we’ll keep working to make that a reality.
You can download the full report at this link.
