OBJECTIVES: Overview of the state of the art and a general framework of the current public hospital drug procurement differences in the most important EU countries, looking for cases of service quality feedback on past contracts used as additional award criteria. METHODS:  Literature review and analysis on public reports investigating the current experience in drug procurement for the hospital sector, in the most important European and OECD countries. RESULTS: The centralized procurement is carried out by Ministry of Health, social health insurance institutions or procurement agency (in Denmark and Norway). Tender is a key tool for procuring medicines for the public sector in many countries worldwide and it is considered to be of high relevance in hospital sector. In some countries as Romania and Slovakia a mix of tendering and negotiation practices take place, while in other countries (Cyprus, Estonia, Italy, Latvia, Malta Norway, Sweden, UK) tendering is largely the most diffuse procedure to procure most medicines for hospitals. Although the introduction of service quality in award criterion, it is just a promise on future activities, the procurement mechanisms lack of a) an effective EU standardization of the procedures; b) feedbacks of supplier quality of the previous services as award criteria (e.g., on time delivery). CONCLUSIONS:  The introduced policy to purchase medicines is tendering with the aim of increasing the health resource saving by lowering contract price. However, the costs originated by a low quality service during contract are not taken into account as an award criterion. The introduction of the quality feedback could induce a reduction of effective low-quality service related costs during the contract.