The temporalities of prices: ‘Value-based pricing’ in pharmaceutical markets

Abstract

In 2019, Zolgensma, a gene therapy for patients suffering from Spinal Muscular Atrophy (SMA), became famous for being ‘the most expensive drug ever’. Its high price was justified by ‘the value’ that the drug will bring to patients and society, illustrating a rationale that has come to be known as value-based pricing. This paper builds on the literature in valuation studies and economic sociology, and on the debates that the case of Zolgensma triggered in France, to provide a conceptual and empirical analysis of a value-based formulation of prices. We argue that formulating prices out of value produces an orientation towards the future which has epistemic and political consequences. We analyse Zolgensma’s value-based price as a composite of narratives and calculations that operates as a regulatory tool, a contractual arrangement, and an object of expertise. In these different settings, its distinctive temporality questions the commensurability of estimated benefits and desirable futures, the treatment of uncertainty, and the relevance of past costs and future value.