Report | December 2020 | Download PDF

Over the past two decades, rising medicine prices have become an increasingly critical threat to the economic sustainability of health systems across the European Union (EU). To overcome this challenge Member States are seeking solutions outside the EU framework, exploring the possibilities of cross-country cooperation on medicines policy. These governments are seeking a solution to the overpriced medicines and asymmetries of information in the pharmaceutical markets now typical all over the EU by collaborating with their neighbours on information sharing, health technology assessments (HTA), price negotiations and joint procurement.

2015 saw the launch of the first formal cross-country cooperation scheme between EU Member States, the Beneluxa Initiative, which was welcomed by many as a defining moment in the quest for greater transparency and accountability in pharmaceutical markets. The Valletta Declaration Group (VDG) followed in 2017 and at the time of writing there are several formal and informal collaborations active in the EU. The European institutions have also made some moves towards supporting greater integration and collaboration on medicines policy, most tangibly by funding the European Integrated Price Information Database (EURIPID) scheme. This report aims to compare these different approaches to increased integration, determine their suitability for responding to health crises and assess which, if any, is key to the future of access to medicines in Europe.

In many ways, the Beneluxa Initiative, VDG and EURIPID share a lot in common. All are the products of a need for greater collaboration and transparency across Europe when it comes to medicines, and of a political desire to be shown to be taking action. All have the potential to contribute to a new healthcare world: one where decisions on medicines are made between equal players, with patient interests at the forefront. All, to some extent, focus on sharing information as a key step towards making that world a reality. All have had some success, to varying degrees. Beneluxa has the uneasy title of ‘first positive reimbursement decision’, VDG has made its mark on transparency on the global stage, and EURIPID is quietly facilitating greater price information sharing.

These cross-country collaboration initiatives are not simple success stories, however. The experience of Beneluxa shows that the coordination processes are complex and lengthy, that for greater collaboration reforms may be needed to make key national structures and agencies more cohesive, and that there is an acute need for greater transparency. The VDG urgently needs to speed up its processes, and push through some of the medicines the group repeatedly says are under scrutiny—it is difficult to assess the strengths and weaknesses of a group that has not yet delivered. Overall, these initiatives are not yet proving to be greater than the sum of their parts, and political will is needed to amplify them from experiments to a fundamental part of how healthcare works in the EU.

We must also acknowledge that in what could have been a seminal year for these groups, we have instead had to contend with a pandemic that has overhauled priorities, resources and political will. The urgency with which the Covid-19 crisis needs to be resolved has, crucially, presented reasons for countries to look beyond their existing alliances to secure vital therapeutics. And at the other end of the spectrum we could argue that the EU’s proactive approach to negotiating on behalf of all Member States has made cross-country groups less relevant. This move towards greater EU-sanctioned collaboration looks set to continue and could determine the fact of these groups.

There is no argument that cross-country cooperation will be key to access to medicines going forward: but it remains to be seen whether that collaboration will continue outside the EU framework, or be absorbed as a reaction to the positive test that has been the Covid-19 crisis. Either way, we hope to see transparency protected and championed, and collaborative working, information sharing and joint negotiations heralded as the antidotes to the sky rocketing prices and information asymmetry that mean pharmaceutical companies are still in charge of the fate of Europe’s health.

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