Recent Advances in Voluntary European Cross-Border Collaborations in Joint HTA and Drug Pricing/Procurement

OBJECTIVES: Development of high-cost innovative therapies and supply shortages of hospital drugs have led to cross-border collaboration among many European countries to improve access to and secure affordable prices of medicines. This research aims to explore developments in European cross-border health technology assessment (HTA) and drug procurement voluntary initiatives, outside the European Network for Health Technology Assessment (EUnetHTA).

METHODS: A literature review was conducted using publicly available resources—the World Health Organization (WHO) website, national health authorities’ websites, MEDLINE, and grey literature.

RESULTS: Among the 15 European cross-border initiatives established since 2012, only a few have remained markedly active in recent years. The BeNeLuxA Initiative (2015) has successfully completed 2 of 5 joint price negotiations for advanced high-cost medicines and has been actively pursuing horizon scanning and information sharing activities among others. The Nordic countries are increasing their collaboration to pool resources. The FINOSE project (2018), strengthened by the entry of Denmark and prolonged in 2023 for 3 additional years, has conducted 4 joint clinical HTAs. Another collaboration between Denmark, Norway, and Iceland has resulted in 2 successful joint tenders for certain hospital medicines, and has planned increased joint tendering procedures. Furthermore, new collaborations among the EU and extra-EU countries (including the cross-border alliance between the United Kingdom, Australia, and Canada with plans for joint clinical assessment) have emerged.

CONCLUSIONS: Established cross-border alliances, such as BeNeLuxA and the Nordic collaborations are continually active. However, since 2020, no further developments have been publicly available for other initiatives. With the implementation of the new EU HTA regulation, it is expected that existing collaborations will remain more focused on joint economic evaluation and drug pricing/procurement than on joint clinical HTAs. It will be interesting to further assess how these collaborations evolve and affect each other at both EU and extra-EU levels.