OBJECTIVES: Growing costs of innovative medicines have triggered many European countries to start collaboration to improve patient access to high-cost medicines. In response to that, EFPIA recently published its position to support development of such initiatives. The aim of this research was to update the landscape of cross-border drug procurement initiatives that recently emerged in Europe.

METHODS: A literature review was conducted using publicly available resources such as the European Commission website, WHO website, European Federation of Pharmaceuticals Industries and Associations, national health authorities’ websites, Medline^® database, and grey literature.

RESULTS: Thirteen regional initiatives in pharma procurement were established since 2012 including about 30 European countries with main scope of activity including information sharing, horizon scanning, and joint HTA/price negotiations of innovative medicines with few collaborations focused on biosimilars and advanced vaccines. Recently, there has been a growth in collaboration between Nordic countries with Norwegian-Danish procurement initiative established in September 2018. FINOSE project jointly led by Finland, Sweden and Norway is in pilot phase excepted to end in 2020, with two application that were expected for submission by the end of 2018. Valletta collaboration announced prioritisation criteria for joint clinical/economic evaluation and price negotiations and six products have been already selected for work. To date, only BeNeLuxA-I have been confirmed with successful joint HTA and price negotiations of nusinersen in spinal muscular atrophy. Norway and Denmark entered price negotiations of nusinersen in 2018 but apparently had failed to succeed.

CONCLUSIONS: Several cross-collaboration initiatives on joint drug procurement have emerged over last 7 years in Europe. So far results show that focus is set on costly orphan drugs targeting vulnerable population of patients with significant unmet needs and BeNeLuxA-I is paving the way for success. Despite that, cross-country collaborations still need to overcome significant hurdles to become truly effective.