Drug pricing in the European Union has never been an ideal system. In recent years, the rise of pandemic health threats such as Aids and bird flu and the accession of poorer states have highlighted its imperfections. So when Markos Kyprianou, the EU health commissioner, this month called for reforms to enable poorer states to face global health challenges he provoked an important and timely debate.

Within the EU there is only a partial correlation between drug prices and per capita income. But the accession of poorer countries has increased both the number and the extent of the exceptions to this trend.