OBJECTIVES: Due to the high cost of pharmaceutical products, the European Union (EU) health care systems, particularly in low-resource settings, have begun to voluntarily enter cross-border collaborations in order to improve patient access to health technologies. The aim of this study was to identify and discuss the aims of the agreements and collaborations available across Europe as efforts made to address the challenges of the healthcare market.

METHODS: A literature review through PUBMED, EMBASE, and additional websites, was conducted to identify policy initiatives and opportunities in EU countries.

RESULTS: Since 2012, 9 cross-border collaborations have been established in Europe: 4 collaborations focused on the procurement of innovative medicines: “Valletta Declaration” (2017), “Southern European initiative” (2016), “Nordic Pharmaceuticals Forum” (2015) and “BeNeLuxA” (2015), and five collaborations aimed to facilitate the procurement of pharmaceuticals and medical devices: “Declaration of Sofia” (2016), “Central Eastern European and South Eastern European Countries Initiative” (2016), “Romanian and Bulgarian Initiative” (2015), and “Baltic Partnership Agreement” (2012). Through these collaborations, EU countries tend to centralize medicines purchase in order to present a bigger patient pool to pharmaceutical companies to facilitate lower prices and to ensure continuity of access. Their principal objectives were horizon scanning, information sharing, enhancing transparency and price negotiation. The first Baltic States’ experience (Latvia, Lithuania and Estonia) in purchasing BCG vaccine failed in 2015 because no tender was submitted. Since 2015, there have been several successful joint purchasing of vaccines between Baltic countries (rotavirus vaccine, pneumococcal vaccine).

CONCLUSIONS: Payers’ collaboration can lead to lower drug prices and to development and collaboration on patient registries. However, establishing and implementing sustainable cross-border collaborations in procurement seems to be challenging. Experiences in Europe are still limited and too recent to allow clear conclusions to be derived on these collaborations’ effectiveness and impact.