The narrative that high drug prices are justified by development costs of up to several billion dollars per approved medicines hides the extensive public investment underlying pharmaceutical innovation. Despite substantial public investments –including direct funding, clinical trial infrastructure and regulatory support– current pricing mechanisms fail to account for public contributions. This results in taxpayers "paying twice": first through research funding, then through premium drug prices. The absence of standardised reporting enables this warped understanding of innovation, where the pharmaceutical industry is portrayed as the sole inventor while public contributions remain invisible.

This handbook presents the HI-PRIX framework for systematically identifying and documenting public contributions to pharmaceutical R&D across eight categories spanning from basic research to post-market evidence generation. Our analysis reveals that the public is not only part of the innovation ecosystem but its main driver.

The European pharmaceutical directive's Article 57 represents a critical step toward transparency, but effective implementation requires standardised reporting frameworks, comprehensive tracking systems, and integration of public contribution data into pricing negotiations. Without such systematic transparency, breakthrough therapies will remain increasingly unaffordable despite their fundamental dependence on public investment, threatening healthcare sustainability across Europe and beyond.