Pincer Moves on European Drug Prices

The EU’s national health organizations are contemplating to abandon their highly-prized autonomy, and forge common positions and buying strategies for accessing expensive new drugs.

The pipe-dreams of national medicines agencies and health insurance bodies of making a common front in dealing with drug firms just came a little closer to reality, in the unlikely setting of a Maltese conference room.

It all started three years ago, when the Dutch health minister and the Dutch-speaking health minister of Belgium decided to put their heads – and some of their key members of staff - together to see if they could get a better deal on paying for expensive new medicines. Subsequently, the Luxembourg and Austrian health ministers signed up to the initiative, and Ireland has hovered on the sidelines too. They have been quietly working away at finding a common approach to negotiating with drug firms, to strengthen their collective hand in the tough pricing and reimbursement talks that always accompany the launch of an innovative medicine.

Small and mid-size countries often feel at a disadvantage sitting alone across the table from major international drug firms making them an offer they feel they cannot refuse for access to a new medicine. Strength in numbers has obvious attractions if they can operate in unison.

That initiative has still to show concrete results, and promised deadlines of reports on outcomes have been repeatedly deferred. But there is no doubt that even before any concrete results emerge, the countries involved are making real progress in terms of clearer understanding of how each of them work, and in defining where they can get synergies out of cooperating when they face up to drug firms.

Bulgaria and Romania have also expressed an agreement in principle to cooperate on acquiring medicines. And earlier this year, talks edged forward on a parallel initiative with Greece and half-a-dozen countries in the Balkans exploring how they could get more bang for their bucks by working together when they had to face big pharma in hard-fought pricing talks.
Now, however, the game has got suddenly more serious. At an early-May meeting of drug agencies from the southern half of the European Union, six of them signed a pact to cooperate on joint procurement of drugs. And this time it isn't just smaller or poorer countries that are involved. The Valletta Declaration – as it is called, in honor of the Maltese hosts – brings together Spain and Italy, as well as Cyprus, Malta, Greece and Portugal.
The trend is obvious: north, east and south, national health organizations are viewing the challenge of access to expensive new drugs so seriously that they are prepared to contemplate abandoning their previous highly-prized autonomy, and forge common positions and common buying strategies. Europe's health ministries are waking up to the merit of the tried and tested formula that has for years offered economies of scale and sharpened purchasing power to major customers in every other branch of commerce and industry.
As the Maltese hosts for this meeting remarked: "The establishment of a robust pharmaceutical system has highly improved the outcomes from the use of medicines for citizens in the European Union. However, guaranteeing access to new and innovative medicines in an era of ever increasing healthcare demands puts major challenges on the sustainability of health systems. There remains major scope for exploring new solutions to ensure the best balance between access to innovative medicines, safety and sustainability of national health systems."
That scope is now being explored as never before.

Peter O’Donnell is a freelance journalist who specializes in European health affairs and is based in Brussels, Belgium.