Pricing of in-patent pharmaceuticals in the Middle East and North Africa: Is external reference pricing implemented optimally?

•Across the region, ERP is seen primarily as a cost-containment tool.•MENA countries do not implement a formal value assessment system for prescription medicines.•The ERP systems in the MENA region are largely not designed and implemented in line with ERP best practice principles.•Changes to ERP systems in the short-term can include improvements in basket country selection, price revision frequency, and use of ex-factory rather than retail prices.•A long-term goal for MENA countries should be to minimise dependence on ERP and develop their own value assessment systems.