OBJECTIVES: Tendering is adopted to buy medicines based on a competitive bidding process where the contract is granted to the pharmaceutical supplier who offered the best bid, according to predefined criteria. Through tenders, healthcare systems have the opportunity to increase the competitive environment and to reduce drug acquisition costs while achieving price reduction, especially when off-patent medicines are available. The aim of this study is to analyze drug-tendering process differences across Italian regions, through the assessment of structural differences and competitiveness dynamics, with a focus on off patent drugs.

METHODS: A descriptive analysis of all tendering procedures with undisclosed price information, adjudicated in the year 2021 in 21 Italian regions, was performed. More than 500 tenders and 10,000 lots were analyzed. Data were extracted from a Farmadati proprietary database. Variables explored included both structural (e.g. geographic level, type of procedure, length, number of participants, quantities, award criteria) and price competitiveness (e.g. bidding price, bidding offers).

RESULTS: Decentralized subregional tenders were usual in Piemonte, Veneto, Marche, Campania, Calabria e Sicilia, while Friuli V.G. Toscana, Abruzzo and Umbria implemented mostly centralized regional procedures. Multi-regional tenders emerged in three regions. The most adopted awarding criteria was the “lowest price”. As regard to price dynamics, the bidding prices were frequently lower than mean unit official ex-factory prices, ranging approximately between -60% and -2% (interquartile ranges). In presence of off patent drugs, this difference increases, ranging approximately between -80% and -7% (interquartile ranges).

CONCLUSIONS: The analysis showed that there is high regional variability as regard to purchasing schemes and price competitiveness among Italian regions. In an already fragmented context in terms of drug access policy, the heterogeneity in the tendering system might further contribute to increase disparities in access to drugs, especially in presence of off patent drugs.