BeNeLuxA et al.: the best is yet to come

The intergovernmental regional initiatives of collaboration around access to medicines policy are here to stay. Zooming in on the BeNeLuxA coalition, the most advanced of the regional European clusters (henceforth the regionals), this reflection paper analyses the multi-layered cooperation, looks at the progress achieved so far and tries to foresee the challenges and opportunities along the way for these alliances in Europe.

A new culture of cooperation is being fostered among the civil servants of the participating Member States who pool resources, build capacity and exchange information and expertise. Above all, they are learning to trust each other. In the face of excessive medicines’ prices, the regionals are a pragmatic and irreversible political choice for all parties involved. Put simply, if they were to fail, there would be little else to fall back on.

The International Horizon Scanning Initiative (IHSI), a Beneluxa spinoff has created an additional, new platform of exchange for public authorities. Its primary objective is to mitigate the effects of the information asymmetry which undermines governments’ leverage in the negotiations with pharmaceutical companies. This early warning system will provide public administrations with more and better information about what is in the companies’ pipeline. Combined with a joint determination and upfront public announcement of the willingness to pay, public authorities hope to be able to break the “sky’s the limit” pricing strategies of pharmaceutical manufacturers. This will have implications for transparency in prices and in medicines’ pricing, the market and competition dynamics; as well as the future of biomedical innovation and investment decisions both for countries and pharmaceutical manufacturers.

Beneluxa is not just about lowering medicines’ prices. In fact, it is not even about joint price negotiations per se. It prioritizes the optimization of the various preparatory building blocks that may or may not eventually lead to joint price negotiations. This is what perhaps makes it stand out compared to the other regionals. In the past four years, Beneluxa has created the conditions for a multi-layered, continuous cooperation and exchange of information amongst its members.

The paper concludes that when all parties share the same information, whether or not, in the end, multiple governments will carry out joint price negotiations becomes a secondary issue. They can negotiate individually should they decide to do so, but companies will in any case, expect to deal with a de facto united front, thanks to the same baseline of information, reinforced by the jointly determined willingness to pay.

That said, willingness to pay does not mean, nor necessarily leads, to affordable prices. Someone might well be willing, prepared or able to pay two million euro per patient to cure cancer, but this might also equal rationing access due to lack of affordability, effectively denying access due to cost, which is the challenge faced by most in the current system. Also worth noting is that the proposed “solution” does not bring about a radical overhaul of the system. On the contrary, it may be considered to be a piecemeal solution which feeds into and maintains the status quo and the “innovation is expensive” narrative. Meaningful innovation should not have to be expensive, let alone unaffordable and unsustainable. Innovation needs to be efficient, available and accessible too.

Will Beneluxa as we know it today exist in five years? Probably not. Will the structures it set in place still be there and (better) used by a high number of countries? Undoubtedly, yes.

BENELUXA: First results of multi-country cooperation on medicine price negotiations

Beneluxa: the begginings. The story of the first row of results announced by the participating governments in EPHA’s 2017 reflection paper.

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