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Background  Policymakers and researchers frequently compare the prices of medicines between countries. Such comparisons often serve as barometers of how pricing and reimbursement policies are performing. The aim of this study was to examine methodological challenges to comparing generic drug prices.    Methods  We calculated all commonly used price indices based on 2013 IMS Health data on sales of 3156 generic drugs in seven European countries.    Results  There were large differences in generic drug prices between countries. However, the results varied depending on the choice of index, base country, unit of volume, method of currency conversion, and therapeutic category. The results also differed depending on whether one looked at the prices charged by manufacturers or those charged by pharmacists.    Conclusions  Price indices are a useful statistical approach for comparing drug prices across countries, but researchers and policymakers should interpret price indices with caution given their limitations. Price-index results are highly sensitive to the choice of method and sample. More research is needed to determine the drivers of price differences between countries. The data suggest that some governments should aim to reduce distribution costs for generic drugs.    Electronic supplementary material  The online version of this article (doi:10.1186/s12913-017-2184-5) contains supplementary material, which is available to authorized users.

A comparison of generic drug prices in seven European countries: a methodological analysis