Which Country Is Enhertu (Trastuzumab Deruxtecan) Cheapest In? — 2026 Guide

Why does the price differ so much between countries?

Enhertu (trastuzumab deruxtecan) is a HER2-directed antibody–drug conjugate, jointly developed by Daiichi Sankyo and AstraZeneca, that pairs a trastuzumab antibody backbone with a topoisomerase-I-inhibitor payload delivered directly to HER2-expressing tumour cells. It is approved for HER2-positive and HER2-low breast cancer, HER2-positive gastric and gastro-oesophageal junction adenocarcinoma, and HER2-mutant non-small-cell lung cancer, and is supplied as a lyophilised powder vial reconstituted and administered by intravenous infusion in a hospital or specialist oncology day unit. Because it never leaves institutional custody between manufacture and administration, it is priced and procured through the same hospital-tender machinery used for other infused biologics, not through community pharmacy price lists.

As a newer-generation antibody–drug conjugate, Enhertu sits in a therapeutic space with relatively few direct substitutes at the time a payer first evaluates it, which affects how health-technology-assessment bodies negotiate its price relative to an established class with several competing brands. The complexity of its manufacturing process — a biologic antibody chemically linked to a small-molecule cytotoxic payload — also means its cost basis differs from either a straightforward monoclonal antibody or a conventional chemotherapy agent, which is one reason its evaluation pathway in several health systems has taken longer than for simpler biologics.

In Türkiye, TİTCK applies external reference pricing to Enhertu as it does to other hospital-administered biologics: the published price tracks the lowest ex-factory price found across a defined basket of EU reference countries, converted using the fixed "pharmaceutical euro" (Dönemsel Avro Değeri) rather than the live market rate, as published on the TİTCK price list and gazetted in the Resmî Gazete. Germany evaluates Enhertu under its AMNOG early-benefit-assessment framework, with free pricing for the first months followed by a negotiated price backdated to month seven. NICE in England applies its cost-per-QALY threshold, raised from the long-standing £20,000–£30,000 range to £25,000–£35,000, announced 1 December 2025 and effective from April 2026 (see NICE).

The United States has no equivalent government reference mechanism for a drug like Enhertu: list prices are set largely freely by the manufacturers and negotiated privately with payers and pharmacy benefit managers, and the RAND Corporation's 2022 international price comparison, published 1 February 2024, found gross US list prices averaging 278% of prices in 33 other high-income countries across all drugs. Because Enhertu is hospital-administered, most institutions never pay the published list price at all: they buy through tenders under hospital tender confidentiality clauses that keep the actual acquisition price undisclosed even when the reference list price is public. For more on the structural reasons behind Türkiye's published prices, see our explainer on why medicines cost less in Türkiye.

How is the price set in each country?

The table below compares pricing systems, not prices. Each country publishes — or does not publish — its own official list, and that published list is the only figure worth relying on. Follow the link in the last column and read the current entry yourself.

How can I obtain a medicine legally from a lower-price market?

There is a lawful route in most countries, and it starts in the same place everywhere: a valid prescription in your own name, issued by the physician treating you. What differs is the import permit. The procedures below are stated only where they could be verified at the national authority.

United Arab Emirates. MOHAP operates a permit to import medicines for personal use through its Electronic Drug Establishment service. The permit is free and is issued within 3 working days. You log in with a MOHAP account or UAE Pass.

Saudi Arabia. Applications run through the SFDA Controlled Drugs System at cds.sfda.gov.sa, under a guideline published on 14 August 2025. Read the current SFDA regulations page before you travel — the requirements are revised periodically.

Qatar. For non-controlled medicines there is no pre-approval: you may carry up to a 60-day supply through the Green Channel, in the original packaging, with a copy of the prescription and a signed, stamped letter from your doctor. For controlled medicines you need advance approval and must use the Red Channel; supporting documents must be no older than 6 months and in Arabic or English.

Kuwait and Azerbaijan. Confirm the current procedure directly with the national authority before shipping or travelling — Kuwait Ministry of Health and Azerbaijan Tariff Council. We do not publish a step list for these two countries because the procedure could not be verified at source.

1. United Arab Emirates — obtain a prescription in the applicant's own name, issued within the last 3 months.
2. Obtain a medical report from the treating facility, authenticated by the health authority and issued within the last year.
3. Prepare an Emirates ID or passport copy for the applicant.
4. Log in to the MOHAP service with a MOHAP account or UAE Pass and submit the personal-import application.
5. Keep the quantity within the limit: no more than a 1-month supply for controlled medicines, and no more than a 3-month supply for non-controlled medicines.
6. Wait for the decision — the service is free and normally issued within 3 working days.
7. Contact MOHAP on 800 111 11 or at import.export@mohap.gov.ae if the application stalls.

What is named patient supply?

Named patient supply is the international concept behind almost every lawful cross-border medicine route. The clearest codified example is the United Kingdom's MHRA Guidance Note 14, built on Regulation 167 of the Human Medicines Regulations 2012.

Four conditions define it: the order must be unsolicited; the product must be specified by the prescriber; the prescriber must be directly responsible for the patient; and there must be a genuine special clinical need that no authorised product meets.

The honesty point matters here: the European Court has held that "financial considerations cannot, in themselves" establish a special clinical need. A lower price in another country is not, by itself, a lawful basis for a named-patient import. The lawful bases are clinical.

Is the Enhertu I'm being offered genuine?

No Enhertu-specific falsified-product alert appears in the WHO's medical product alert catalogue as at the time of writing. That absence is not proof that any individual vial you are offered is genuine — it simply means there is no documented incident on file to cite, and any single-dose vial obtained outside a licensed hospital pharmacy still carries the same generic risks that apply to any high-value infused biologic.

Enhertu is dispensed as a single-use lyophilised powder vial that must be reconstituted immediately before infusion, so verification has to happen at the point the vial is received by the hospital pharmacy, before reconstitution, since once the powder is dissolved none of its outer packaging information can be checked again.

Enhertu carries a boxed warning for interstitial lung disease/pneumonitis and for embryo-fetal toxicity, which is one more reason it should only ever be administered in a hospital setting with pulmonary monitoring in place — never self-administered or sourced through an unlicensed channel regardless of any packaging that looks intact.

• Scan the carton's GS1 DataMatrix and confirm it decodes to AI 01 (GTIN), AI 21 (serial number), AI 17 (expiry) and AI 10 (batch) before the vial is accepted into pharmacy stock.
• If the vial is sourced in Türkiye, verify the karekod is notified to the national İlaç Takip Sistemi (İTS) track-and-trace system at its.saglik.gov.tr before it leaves the pharmacy.
• Request a continuous 2–8°C temperature log covering the specific shipment you are receiving, not a generic cold-chain certificate — Enhertu must never be frozen or shaken.
• Cross-check the batch and lot number against the WHO's live list at our WHO falsified medicine alerts tracker before it is dispensed for reconstitution.
• Confirm the vial label, lyophilised cake appearance and reconstitution instructions match the AstraZeneca/Daiichi Sankyo product information exactly before preparation begins.
• Never accept a vial with damaged, re-labelled or resealed packaging, or one offered outside licensed hospital-pharmacy distribution, regardless of the price quoted.
• Review the full verification workflow in our guide to checking that a medicine is genuine.

Frequently asked questions

Sources

• Resmî Gazete — Beşeri Tıbbi Ürünlerin Fiyatlandırılmasına Dair Karar No. 11031 — retrieved: 2026-07-28
• TİTCK — published medicine price list — retrieved: 2026-07-28
• MOHAP (UAE) — import medicine for personal use — retrieved: 2026-07-28
• SFDA (Saudi Arabia) — regulations — retrieved: 2026-07-28
• SFDA Controlled Drugs System — retrieved: 2026-07-28
• Qatar MOPH — drug prices — retrieved: 2026-07-28
• Kuwait Ministry of Health — retrieved: 2026-07-28
• Azerbaijan Tariff Council (Tarif Şurası) — retrieved: 2026-07-28
• NICE (United Kingdom) — retrieved: 2026-07-28
• G-BA (Germany) — AMNOG benefit assessment — retrieved: 2026-07-28
• RAND — International prescription drug price comparisons (published 1 Feb 2024) — retrieved: 2026-07-28
• Frontiers in Pharmacology — European hospital price transparency study (9 Mar 2026) — retrieved: 2026-07-28
• MHRA Guidance Note 14 — supply of unlicensed medicinal products — retrieved: 2026-07-28

Country availability pages for this medicine

Related pages

Antibody–drug conjugates

Related high-cost medicines