What is behind the price of antigen tests in Spain?

Maica Fernández Colomer
Teacher Assistant of the programs in Health and Pharmacoeconomics
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“Hello, are there any antigen tests left? And how much do they cost?” have probably been the most repeated questions in Spanish community pharmacies during the last two months. Obtaining an antigen self-test has become an odyssey for many Spaniards. With the unstoppable arrival of the sixth wave of SARS-CoV-2, whose protagonist has been the Omicron variant, the free sale of this type of test has also arrived in the country. This test allows the result to be obtained in just 15 minutes, presenting a high sensitivity in the first days of infection, and has been the main dish of Christmas 2021. The sale of antigen tests increased by almost 70% in the penultimate week of 2021. From 20 to 26 In December, pharmacies sold 7,050 million of these tests, becoming the record since the start of the pandemic, according to data provided by the consulting firm Iqvia.

Shortage. Law of supply and demand

The high demand and distribution delays caused a shortage problem and, therefore, a significant increase in prices. All of the latter conforms to the strongest law that prevails in the market: the law of supply and demand. When the quantity demanded is greater than the quantity supplied, suppliers increase the price. Luis González Díez, president of the Official College of Pharmacists of Madrid (COFM) assures that pharmacies, short of supplies, have had to adapt to the prices of their suppliers. This has made Spain one of the European countries with the highest price of antigen tests.

In contrast to Spain, in other European countries the sale of these tests has been much easier, faster and less expensive.

Exorbitant prices in Spain

The main reason why until now the price of tests varied so much from one pharmacy to another is very simple: the free market prevailed. The prices of antigen tests are exempt from VAT, but were not regulated by the Government. This means that manufacturers, laboratories and pharmacies could sell them at whatever price they saw fit. Pharmacies requested them through distribution companies and each distributor had its own purchasing conditions. Therefore, the manufacturing laboratory set the starting price it considered and the retail price was freely stipulated by each pharmacy. In contrast, in other European countries the sale of these tests has been much easier, faster and less expensive.

• In Germany, the government offers totally free weekly tests to its citizens. Also, in supermarkets such as Aldi they are for 1.79 euros and in pharmacies they became cheaper until they had a price of 0.69 euros.
• In the United Kingdom, they offer tests at no cost at home that can be requested through the Central Government website as long as certain requirements are met.
• In France, there is a free quota and the price is regulated by law with a maximum of 6.10 euros.
• In Portugal, they are even sold in supermarkets such as Mercadona for 2.10 euros per unit, offering citizens a free trial every 15 days.

In Spanish pharmacies, the prices of this type of self-consumption test have ranged on average between 5 and 8 euros, depending on the Official Colleges of Pharmacists of each Autonomous Community. Furthermore, in general terms, pharmacies' gross margin has ranged between 25% and 50%, in some cases exceeding these percentages.

January 15, 2022: The maximum price of 2.94 euros per test in Spain comes into force

The Interministerial Commission on Drug Prices (CIPM) is the competent body for setting the prices of drugs that are financed in the National Health System (SNS). On January 13, 2022, the CIPM unanimously approved setting the maximum amount for sale to the public of antigen tests after the great demand derived from the sixth wave, which has even tripled its price. The cost of antigen tests from other countries has been the main refferent to set the maximum price at 2.94 euros. According to the Minister of Health, Carolina Darias, the margin has been taken into account in the commercial framework of pharmacies considering that the product is exempt from VAT. The objective has been set a price that is as affordable as possible, always maintaining the necessary balance for the product to be available in the pharmaceutical channel. Said resolution is based on the article 94.3 of the Law on guarantees and rational use of medicines and health products, which indicates that “the Government may regulate the Mechanism for setting the prices of medicines and health products not subject to medical prescription, as well as other products necessary for the protection of the health of the population when there is an exceptional health situation.”

Any measure that helps facilitate access to the citizen, such as the sale of tests in supermarkets, is welcome.

Luis González Díez applauds the regulation, but, like many citizens, considers it late. He affirms that now the price is regulated only because the market will be supplied, as happened with the masks (which are now lying on the ground and before it was an ordeal to get them).

Should the antigen self-diagnosis test be sold outside of pharmacies?

Currently, the National Commission for Markets and Competition has opened a new debate in which they recommend that the Government eliminate the monopoly on the sale of these tests to pharmacies and open it to large stores, as is the case in countries such as Portugal , France or Germany. However, Carolina Darias is not in favor of this consideration of the CNMC, since she considers that a medical device must be sold by a knowledgeable professional in addition to the fact that the pharmacy is empowered to communicate a positive case.

Rectifying is wise, and, fortunately, the situation has normalized and regulatory measures have been taken. With this, it is hoped that on future occasions this type of necessary measures will be taken with greater anticipation and initiative, and everything that facilitates access to the citizen, such as sales in supermarkets, is welcome.