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Introduction
The role of medicines in healthcare systems globally is becoming more important as innovative treatments become available to address unmet clinical needs at the same time that economic development and the imperative of universal health coverage become drivers of expanded access. In 2014 it is estimated that $1 trillion will be spent on medicines of all types globally.1

Understanding the full set of activities that occur prior to a patient receiving a medicine provides useful perspective on the pharmaceutical value chain, including the specific elements of that chain, the value that is provided at each step and the cost components that are incurred. These can differ both between and within markets depending on the type of medicine, channel of distribution, reimbursement regulation, or geographic region. Country comparisons underscore the extent to which health systems differ in a multitude of ways and for many reasons.

The purpose of this report is to advance the understanding of the pharmaceutical value chain and specifically to:

1. Describe the elements of the medicine value chain and outline factors and costs that contribute to the difference between the net price a pharmaceutical manufacturer receives for a drug and the final amount paid for the drug by the end user.

2. Quantify the price build-up for specific therapy areas and countries.

3. Illustrate the diversity of approaches and costs associated with the value chain through case studies.

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