PCP15 - WHY EUROPEAN CROSS-BORDER INITIATIVES ON DRUG PROCUREMENT MAY FAIL?

Abstract

Over recent years, ten European cross-country collaborations for drug procurement emerged to contain pharmaceutical costs. These initiatives encompass thirty countries. Although they share multiple objectives, the ultimate goal is a joint procurement of expensive medicines, leveraging the population size of involved countries. The prominent one is the Valletta Declaration. It gathers countries with a broad range of GDP and population size. The lack of operational framework is delaying the procurement initiation. To be attractive, they should operate like a single market with a unique price and a simultaneous access; however it is unlikely due to heterogeneous affordability. Due to subsidiarity principle of pricing policies, delegation of price negotiation to Valletta group will require national legislation. Large countries are not ready to give up their additional negotiation power and are looking for a second national negotiation, while smaller countries expect a single negotiation and a same net price for all countries. Low GDP countries expect subsidies from high GDP countries through differential pricing to ensure simultaneous launch which may not happen. Some countries, such as Spain and Portugal have organised joint tenders for generics and biosimilars until the Valletta framework is clarified. BeneluxA-I is expected to be the most promising collaboration; it gathers homogeneous countries with close culture and vision. The first attempt for joint procurement failed highlighting the limited power negotiation despite a quite well established framework. Other initiatives gather small countries, except Poland, with low affordability making them unattractive for providers to offer significant rebates. The top five markets in EU represent 75% of the whole European market providing them a strong negotiation power and leaving the smaller markets unease to achieve substantial discounts even when joining forces. Joined procurement requires a European Union engagement together with a differential pricing to help low affordability countries.