Strength in Numbers

Over the last several years, countries have shown an increased willingness to work together on access to medicines. These initiatives aim to improve the management of financial resources and/or enhance timely and efficient patient access to innovative therapies.

This 2020 WHO report assesses five government-led, voluntary cross-country collaborations that aim to improve access to essential medicines through joint activities: the Baltic Procurement Initiative, Beneluxa Initiative, Fair and Affordable Pricing, Nordic Pharmaceutical Forum and Valletta Declaration.

There are currently 35 cross-country collaborations identified worldwide.

It's an attractive idea – strength in numbers. By joining forces, EU MoHs would wield more bargaining power based on their combined patient pool. For example, the Valletta Declaration represents almost 160Mn people.

Pricing is the most politically sensitive of efforts. Other work includes assessing the therapeutic benefit of new drugs as well as horizon-scanning. While each group has its own potential advantages, reimbursement complexities combined with legal differences have made intergovernmental cooperation challenging.

A lot remains to-be-determined. Will prices be set and fixed for all countries as a group? Will drugmakers have to negotiate with each national authority or as a collective? Will prices be confidential or publicly disclosed? Are decisions binding across all members or will countries have the ability to negotiate on-the-side?

While chinks-in-the-armour remain, the fact that countries are falling into formation is an encouraging sign that the concept could prove its game-changing potential.