The price of access: Industry and regulators are at odds over Nordic drug costs

“The whole industry is aware of the fact that the number of pharmaceuticals that really get to patients in Europe is getting fewer and fewer,” says Anna-Kaija Grönblad, Chief Commercial Officer for Swedish pharmaceutical companyBioArctic.

“We know that it’s tougher and tougher and it takes longer and longer because the willingness to pay for new innovation has decreased.”

“It’s so clear that I would say that we can’t take access to new medicines for granted anymore,” adds Sofia Wallström, CEO of Lif, the trade association for the research-based pharmaceutical industry in Sweden.

We know that it’s tougher and tougher and it takes longer and longer because the willingness to pay for new innovation has decreased.

Pharmaceutical companies are reluctant to introduce newdrugs into the Nordic countries because they fear that sellingthem at a lower price would lead to a financial loss. And if a drug is not approved for use, companies are left frustrated – especially if they developed it.

Cost effectiveness and value-based pricing have long beencornerstones of the healthcare systems in Sweden and the other Nordic countries. But making decisions based exclusively on pricing can negatively impact both patient care andthe region’s ability to attract clinical research projects, pharma-ceutical companies argue.

“With the global shifts in the market that we see today, low prices can never be the objective, if the pursuit of low prices means that patients must wait longer for new treatments,” Wallström says. “If new medicines are not launched in Sweden at all or very late, Sweden will continue to lose out on investments from research-based pharmaceutical com-panies and production as well. Access to new treatments is a crucial factor in building a strong life science nation.”

Small markets are hit hard

While Sweden can boast some of the lowest pharmaceuticalprices in Europe, that comes with a different cost.

“Access to new medicines has declined quite significantlyover time,” Wallström says. “And on top of that, we’re seeing great shifts in the global markets now, so it hits Sweden, Iwould say, particularly hard, as a small market with low pricesand a slow uptake.” 

With policies like the US Most Favored Nation mecha-nism, a drug price agreed upon in a small country like Denmark, representing just 0.3% of the global market, might now directly impact pricing in the US, which accounts for more than 50% of the global market.

Denmark is coping with the same problem, according to Thomas Senderovitz, CEO of the Danish Association of the Pharmaceutical Industry (Lif). 

“Payers insisting on low prices from pharmaceutical companies, and continuing to pressure them for even lower prices, will result in fewer new and innovative treatments because it creates a commercial risk for global companies,” Senderovitz explains.

“If launching in Denmark threatens their primary revenue streams globally, launch strategieswill shift. The real consequence is that patient access to new and innovative medicines may be severely delayed.”

Further complicating matters is America’s Most Favored Nation (MFN) policy regarding pharmaceuticals, adopted in 2025. The policy’s goal is to reduce drug prices for Americans by measuring their cost against the lowest price for the same drug in wealthy countries. Other nations pay more for the drugs, theoretically lowering the prices for Americans. But that puts smaller nations like those in the Nordics at a disadvantage. 

“With policies like the US Most Favored Nation mecha-nism, a drug price agreed upon in a small country like Denmark, representing just 0.3% of the global market, might now directly impact pricing in the US, which accounts for more than 50% of the global market,” Senderovitz adds.

Sweden pushes back

Micke Svensson, however, Coordinator negotiation for the Regional Cooperation Model for Pharmaceuticals at the Swedish Association for Local Authorities and Regions (SALAR), which works closely with the Council on New Therapies (NT Council), says that when it comes to prices for new drugs, Sweden is just as competitive as other coun-tries. “Our view is that prices in Sweden for newer pharma-ceuticals are on par with most comparable countries in Europe,” Svensson says. 

Our view is that prices in Sweden for newer pharma-ceuticals are on par with most comparable countries in Europe.

“Unfortunately, comparison is very difficult or almost impossible since confidential terms [for pricing] are applied to a very large extent due to demands from the industry. We haven’t seen innovative treatments that have cleared the EU regulatory process shut out of the Swedish market,” he says.

Swedish authorities are also showing more flexibility whenit comes to pharmaceutical prices, Svensson says. Periodically the Swedish government gives the nation’s pricing authority, the Dental and Pharmaceutical Benefits Agency (TLV), authority to balance drug price levels with the demands for new treatments. In 2025, for example, TLV decided to raise the ceiling for how much it will pay for medications that treat severe and rare diseases.

“Sweden also has an effective system for generic substitution, which contributes to fast price reductions when a patent expires,” he adds.

Since deciding to consider higher payments, TLV has reimbursed several more expensive pharmaceuticals, accor-ding to Svensson. “Agreements that included confidential price reductions between the company and the regions were often needed,” he says. 

Between January 2025 and April 2026, TLV made decisions on 19 medicines for conditions that have orphan desig-nation, according to the European Medicines Agency (EMA). Of these, TLV granted reimbursement for 14 medicines, Svensson states. Two of the medications that qualified for reimbursement are Myalepta (a prescription medicine used alongside a diet to treat complications of lipodystrophy) and Strensiq (a prescription enzyme replacement therapy used to treat pediatric-onset hypophosphatasia).

“Eight of the reimbursed medicines were assessed according to TLV’s standard criteria and six under special criteria reflecting a greater willingness to pay,” he says. “In five of these cases, negotiations between the company and the regions helped reduce the costs, enabling TLV to grant reimbursement. At the same time, there were two additional medicines that met the criteria, but for which TLV was nevertheless unable to grant reimbursement because the cost was considered too high.”

“More must be done”

Those in the pharmaceutical industry, though, say more mustbe done to ensure patients have access to the latest treatments. Recently the Swedish NT Council officially recommended that regional health authorities delay using Leqembi (leca-nemab), an Alzheimer’s drug developed by BioArctic and Eisai, in public hospitals, saying the annual treatment cost is too high and the company’s price demands are too high for regional budgets to sustain. 

But the drug, which is designed for people in the early stages of the disease to help slow its progression, is already being used by tens of thousands of people worldwide, says Gunilla Osswald, BioArctic’s CEO. “So of course, we were hoping that Swedish patients would also have the opportunity to get it.”

We will do everything we can to continue to help patients receive innovative treatments and also give access to Leqembi in a responsible way and to the right patients.

Currently, private clinics in Finland are providing Leqembi, and a private clinic in Sweden is also planning to offer it to people who are willing to pay for it. Clinics in other Nordic countries are interested as well, and positive results in the clinics could help build awareness, leading to public funding.

“We will do everything we can to continue to help patients receive innovative treatments and also give access to Leqembi in a responsible way and to the right patients,” Osswald says. “So, the first part is to help and support the private clinics.”

The Swedish NT Council indicated that with more data or new approvals, such as the Leqembi maintenance dose, which is currently being reviewed by the EMA, it would be willing to restart negotiations regarding a potential recommendation for reimbursement.

Raising awareness

The pharmaceutical associations are also increasing their efforts to encourage government agencies to look at the broader picture when it comes to paying for medications.

“The big challenge for us is helping our members navigate the very complex geopolitical reality while also pushing to create strong awareness in the public debate here in Denmark and in Europe,” Senderovitz says. “Both are very important tasks.”

Educating people about the process involved in introducing medications is a critical part of Lif’s role in Denmark, continues Senderovitz. 

“For us it is crucial to secure awareness and understan-ding of the global commercial constraints that companies face, and to continue the positive dialogue on solutions with key political and administrative stakeholders,” he says. 

“It is very much about recognizing that an ambitious health policy securing patients’ fast, equal access to innovation is a precondition for Denmark’s standing as an attractive life science nation for investments,” he adds.

Signs of shifting views in Denmark in-clude the government’s MFN Task Force, which plans to address the issue of lower prices head-on, and what Senderovitz called “the long-awaited” evaluation of the Danish Medicines Council, which is now underway. 

I don’t really see this only as an industry issue. Companies make global decisions about where they want to launch medicines and where they want to invest in research, clinical trials, and production, and Sweden needs to understand where it stands from a global perspective in order to compete for those launches and investments.

“We are advocating for a thorough review of the Council’s mandate and framework. We are dedicated to ensuring that Denmark remains an attractive market for life science investments and the launch of new innovative medicines,” he says.

Without adjustments to the payment system, Sweden risks losing not only access to innovative treatments but also its status in the life science community, notes Wallström. 

“This is really a challenge for Sweden and Sweden’s competitiveness, our attractiveness as a market,” she says. 

“I don’t really see this only as an industry issue. Companies make global decisions about where they want to launch medicines and where they want to invest in research, clinical trials, and production, and Sweden needs to understand where it stands from a global perspective in order to compete for those launches and investments,” Wallström concludes.