[13]: 190 ERP is a widely accepted tool to design cost-containment policies, used in the European Union, Brazil, Jordan, South Africa, Canada, and Australia.
[13]: 191–192 As of 2019[update] ERP superseded or completed older cost-containment strategies such as cost-plus or internal reference pricing.
[8]: 302 [2]: 13 European countries which were affected by the global financial crisis have reported restricted access to essential medicines.
[8]: 302 Drug prices are reevaluated regularly in European countries, ranging from 3 months in Greece, to 5 years in France.
[8]: 302 Furthermore, with the widespread adoption of ERP, pharmaceutical manufacturers are developing counter strategies to limit the negative impacts on them, such as reduced drug prices.
[8]: 302 This increase in the launch delay of new medicines is however observed to some extent in all European countries implementing ERP.
[16][23] High medicine price and availability are the two crucial obstacles preventing one-third of the global population,[11]: xi, 1 [13]: 189 or about two billion people,[10]: 209 mainly in low and moderate-income countries (LMICs, as defined by the World Bank),[24] from accessing needed medication.
[25]: 27 Whereas European Union and OCDE countries have put in place shared regulated medication cost-containment systems, low and moderate-income countries did not and lack health-care information systems to help in policy decision making, which worsened their situation as "price acceptors".
[26] Furthermore, medicines prices are usually high, particularly in the private sector and up to 80 times the price in high-income countries; availability can be low, particularly in the public sector; treatments are often unaffordable, requiring 15 days of wage to buy a 30 days treatment; government procurement can be inefficient by buying expensive original medication as well as cheaper generics; and numerous taxes and duties are being applied to medicines, including essential ones.
[11]: 4 These issues were observed in China, an upper-middle-income economy,[24] with its bribery scandals involving GlaxoSmithKline and Sanofi.
[8]: 303 As of 2017[update], a systematic review found that markup regulation and ERP are the most commonly implemented drug pricing policies in LMICs, followed by cost-plus and the use of generics.
[8][13]: 200 [28]: 9 This sets a reference price for a class of equivalent or similar therapeutic agents, the rest being paid out-of-pocket by the patient.