Tendering for off-patent outpatient medicines: lessons learned from experiences in Belgium, Denmark and the Netherlands

Abstract

Objectives To study the impact of tendering for off-patent outpatient medicines in terms of savings for payers and availability of medicines, to explore stakeholder perceptions and to elaborate prerequisites for a successful implementation of the policy. Methods We selected three case studies (Belgium, Denmark and the Netherlands). Information was collected through literature review and stakeholder interviews. Key findings The three case study countries used tendering in different designs. While Dutch health insurers have been tendering for off-patent medicines for more than a decade, Belgium applied this policy for only two substances in 2007/2008 and then stopped. Denmark has a kind of tendering practice: pharmaceutical companies have been submitting biweekly price bids for reimbursable outpatient medicines to the Medicines Agency since the mid-1990s. Stakeholder perception varies between the countries: generic industry, pharmacists and partially patients tend to oppose the tendering practice; in Denmark, however, the system is highly appreciated by all stakeholders. All three countries reported savings for public payers. Experiences related to availability limitations were mixed (Belgium – the winner of the second tender had no capacity to procure; Denmark – no indication of availability limitations; and the Netherlands – frequent medicine shortages, both for tendered and nontendered medicines). Conclusions The findings suggest that tendering for off-patent medicines is able to contribute to cost-containment. However, as the policy possibly risks leading to availability limitations, it has to be strategically designed to avoid or at least deal with shortages through backup mechanisms. Further prerequisites for a successful introduction of tendering include a robust legal and organisational framework, an appropriate stakeholder management and demand-side policies to promote generic uptake.