Over the past two years, cross-border collaborations in HTA and procurement have been implemented in the Nordics. These are the joint procurement of hospital pharmaceuticals on behalf of the Norwegian, Icelandic and Danish Authorities, and FINOSE, a HTA collaboration network between Fimea (Finland), NoMA (Norway) and TLV (Sweden). The aims of joint procurement are to ensure better security of the supply of medicines, and to optimise pricing opportunities. The FINOSE collaboration aims to ensure earlier access to drugs through cooperation on assessment of relative efficacy and effectiveness outcomes in economic evaluations.

These collaborations have the opportunity to provide both financial and administrative benefits to both pharmaceutical companies and appraisers. The FINOSE collaboration can reduce the burden on pharmaceutical companies and their affiliates by limiting the number of submissions, with country-specific components relating to costs in economic models. Individual agencies are still responsible for reimbursement decisions, however it is not yet clear exactly what country-specific documentation will be required alongside the FINOSE submission.

The procurement procedure is largely aligned with current tendering processes in Denmark and Norway, with the opportunities for multiple winners and rankings. The joint procurement process can provide some financial stability to manufacturers, with prices being fixed in Euros and converted to local currencies once annually, although revenues in local currencies may vary year-on-year. Additionally, security against weaknesses in the exchange rate of local currencies is provided by the minimum price being the lowest of the conversion or an existing price set locally. Prices will also remain confidential in the cross-border agreements.

Looking forwards, Joint Nordic Procurement aims to include novel pharmaceuticals, and FINOSE agencies are keen to explore options for outcomes-based contracting and integrate real-world evidence into appraisals. How Nordic HTA processes and Nordic procurement will align with each other is yet to be seen.