Boosting cross-border collaborations and joint procurement to improve access to new medicines in Europe

DISCLAIMER: All opinions in this column reflect the views of the author(s), not of EURACTIV Media network.

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By Dr. Ward Rommel, Chair, Access to Medicines Task Force, Association of European Cancer Leagues

Existing cross-border collaborations have shown that pooling resources can facilitate access to new medicines for patients at a fairer price. At the same time, the potential of the EU Joint Procurement Agreement reaches beyond vaccines and treatments for communicable cross-border health threats. Cancer leagues call on national governments to systematically consider cross-border collaborations for the sake of patients and national health budgets.

What’s the issue?

New high-priced cancer medicines with limited evidence of their added value compared to existing alternatives have been launched in various European markets in recent years. High prices are a major barrier to accessing medicines for patients and a threat to health systems, even in some of the richest countries in Europe and the world.

The increasing calls from cancer leagues, NGOs, payers and other stakeholders to make cancer medicine prices fairer require urgent action to guarantee patient access to drugs with proven patient benefits.

The information and power asymmetry between the multinational pharmaceutical industry as the vendor and national governments as buyers is assumed to contribute to unsustainable drug budgets and difficulties with thoroughly assessing the proven clinical benefit of new drugs.

What can the countermeasure be?

We are experiencing a new trend of collaboration among countries.

Until 2012, each national government negotiated with pharmaceutical companies on a bilateral basis and intergovernmental cooperation on medicines was not a thing. In the last 9 years, we have seen different types of cross-border and cross-country collaboration initiatives – “cross-border collaborations” and “cross-country collaborations” are used interchangeably in this article, as there are no set definitions of the two terms – mushrooming across Europe.

Initiatives such as BeNeLuxA, the International Horizon Scanning Initiative or the  FINOSE Collaboration gather several countries willing to work together on concrete projects (such as health technology assessments (HTA), public procurement, horizon scanning or price negotiations) with the aim to enhance timely and efficient patient access to innovative therapies and relieve health care budgets .

Of note, in 2015, the Dutch, Belgian and Luxembourgish Ministers of Health signed an historic declaration of intent to jointly negotiate with the pharmaceutical sector on the price and reimbursement of some medicines. They were later joined by Austria and Ireland, and several other countries have expressed an interest.

As a result of a successful joint HTA and price negotiations, Belgium, Ireland and the Netherlands were able to increase their purchasing power and have jointly reached an agreement on the price of a drug for Spinal Muscular Atrophy. This example demonstrates that finding a balance between sustainable health systems and access to innovative medicines is possible.

We, at Association of European Cancer Leagues (ECL) and the European Fair Pricing Network (EFPN), have followed this initiative and the BeNeLuxA developments with great interest.

Cross-border collaboration initiatives as the way forward

We know that there are no simple solutions to solve issues related to the accessibility, affordability, and availability of cancer treatments.

There is a sound rationale for increased collaboration among countries in the procurement of health technologies to (i) enhance the understanding and transparency behind the price of medicines and cross-border learning through more information, experience sharing, and horizon scanning, (ii) to strengthen bargaining power and aim for fairer  prices through joint negotiations, (iii) to ensure the sustainability of healthcare systems and allow them to secure access to new health technologies, and last but not least  (iv) to send strong signals to pharmaceutical companies about national priorities and what countries consider as fair prices for these innovations.

The paper of ECL will help countries to establish new and reinforce existing collaborations. It contains concrete guidelines and makes clear that countries can start with feasible projects, such as exchanging information or pooling information, and, if successful, gradually evolve towards more elaborated forms of collaboration, such as joint negotiations.

Civil society organisations can play an important role, if we let them

The current pharmaceutical system is designed for the industry. We strongly believe that civil society, whose interests are not commercially-driven, can and should play a bigger role in identifying unmet needs of the pharmaceutical systems in Europe. These gaps can be solved with increased information sharing and transparency among the stakeholders and across countries.

Civil societies should be part of the conceptualisation, planning, implementation, and monitoring of cross-border initiatives in the healthcare space to ensure successful outcomes to the benefit of patients.

To this end, civil society organisations should seize the momentum and take the opportunity to call on national and European policymakers and regulatory agencies for facilitating cross-border initiatives that can drive a fairer pharmaceutical system in Europe and overcome inequities and inequalities in affordability, accessibility, and availability of new health technologies.

It is critical to raise awareness on the fact that civil society organisations should team-up with like-minded organisations in the national territory to create a common vision and mission, and advocate at regional and national level for more solidarity and cooperation and aim at achieving equal access to medicines.

The current system can use more solidarity and collaboration

The EU Vaccines Strategy is a golden opportunity to extend joint procurement beyond vaccines and treatments to tackle the COVID-19 pandemic.

Indeed, the cancer oncology drug pipeline confronts governments and patients with various hurdles that do not know borders: disparities in access, challenging prices, lack of clear data about patient benefits, and weak systemic involvement of patients in research.

No single country can confront these challenges on its own.

EU policymakers should seize the momentum of solidarity coming from the COVID-19 pandemic and the willingness to come together to face increasingly complex challenges. From a political and diplomatic perspective, acting as a single buyer in the pharmaceutical sector would be a powerful signal of unity. Provided that joint procurement is coupled with robust HTA, transparency over the prices agreed and the terms of reference should be guaranteed.  The terms of reference should not curtail independent academic research with the procured drugs.

In a complementary way, national policymakers should seize the momentum to share experiences, information, and best practices across Europe to streamline regulatory processes, avoid duplication of efforts, and align on principles and criteria that impact price policies.

Cross-border initiatives have the potential to transform the way medicines are currently developed and purchased in Europe, address the current imbalance in the pharmaceutical market, and have positive implications on patient access and the financing of innovation.

Join the conversation

Join our policy dialogue to share your views and hear expert speakers discussing opportunities and challenges for cross-border initiatives and joint EU level procurement.

About the Association of European Cancer Leagues (ECL)

ECL provides a unique platform as the only non-profit, pan-European umbrella organisation with the mission of uniting, at the European level, national and regional cancer leagues to achieve a cancer-free Europe. Active since 1980 and located in Brussels, ECL currently has 30 members from 25 countries in the WHO European Region, covering 20 EU member states. ECL’s members are cancer charities operating across the whole cancer continuum – from cancer research and awareness to patient support during and after diagnosis. ECL is a partner of the European Fair Pricing Network (EFPN) through the Access to Medicines Task Force.

#LetsTalkAccess | @CancerLeagues | www.cancer.eu

About the European Fair Pricing Network (EFPN)

EFPN is an EU-wide collaborative network aiming to put an end to the escalating costs of cancer medicines for the benefit of cancer patients through complementary research and advocacy efforts. EFPN aims to achieve fair prices for cancer medicines and works towards a sustainable pharmaceutical market which produces accessible, affordable and truly innovative medicines for patients, including children and people affected by rare diseases.

EFPN will research the effect of price setting on reimbursement decisions and their relation to the effectiveness of medicines. Research results will shed light on the costs related to medicine manufacturing, marketing, trade and financing of cancer medicines in Europe. The Network aims to further identify strategies to reward better substantiated pricing and translate research findings into tangible political asks directed at both national and European decision-makers.

We warmly invite like-minded parties to cooperate with us and help us achieve fairer prices for cancer medicines and work towards a sustainable pharmaceutical system which produces accessible, affordable and truly innovative medicines for patients. For more information, contact Guy Muller (gmuller@kwf.nl).

#EFPN4Meds | www.efpn.eu

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