The power of joint procurement:
Analysing cross-border initiatives in Benelux and the Nordics

Cross-border cooperation is growing stronger in Europe, with key clusters such as Benelux and the Nordics accelerating joint procurement agreements in order to improve medicine access and increase negotiating power.

In April, the pilot-level Nordic Pharmaceutical Forum (NPF) initiative, representing Finland, Iceland, Norway, Sweden, and Denmark, released an updated strategy document outlining the region’s plans to establish a joint procurement mechanism for medicines, with a declared focus on advanced therapy medicinal products (ATMPs) such as gene therapies.

According to the NPF, the function of its joint tender agreement is not limited to ensuring lower prices and security of supply. Rather, the collaborative framework is also intended to help the region develop on its “green agenda” through the inclusion of environmental criteria, particularly when tendering for older, off-patent medicines.

The Nordic Pharmaceutical Forum was established in 2015 by Danish procurement agency Amgros. Analysts predict that in a few years, the NPF could become a significant voice for bringing forward proposals and concerns around European legislation. According to GlobalData, “the NPF strategy has all the policy elements to ensure the Nordic region continues its status as a ‘recognised cluster’ for cross-country collaboration in Europe.”

We only have to look towards the pilot-level BeNeLuxA alliance between Belgium, the Netherlands, Luxembourg, Austria, and Ireland to see how joining forces can help to improve access to critical medicines in smaller markets. Also launched in 2015, the initiative has successfully conducted several joint negotiations. In October 2021, the alliance completed pricing and reimbursement (P&R) negotiations for Zolgensma, making the gene therapy for spinal muscular atrophy available at the same price in Belgium, the Netherlands, and Ireland.

At the time, Frank Vandenbroucke, the Belgian Minister of Health and Social Affairs said: “BeNeLuxA is still called an Initiative but is in the meanwhile a strong ‘brand’ and gold standard for voluntary collaborations between Member States. Our ability to make Zolgensma affordable for SMA patients in our three countries simultaneously shows that BeNeLuxA’s stated aim to ensure sustainable access to innovative medicines can be translated into tangible and shared results.”

Joint procurement: the pros and cons

For payers, the benefits of cross-border procurement are clear. With such mechanisms originally launched in the 1970s to ensure supply of pandemic countermeasure medicine, their ability to improve access equity is well established. While they continue to be used for joint purchases of infectious disease medicine such as remdesivir during the COVID-19 pandemic, their focus is now shifting towards ATMPs.

By banding together with other countries, smaller nations have more power to negotiate lower unit prices. Considering the high price points of ATMPs, this is a clear benefit for buyers and a potential downside for pharmaceutical companies.

On the other hand, by engaging with alliances such as BeNeLuxA and the NPF, pharmaceutical companies can find opportunities to increase sales revenue by accessing countries that were previously out of reach due to unfavourable market conditions. In addition, they may benefit from increased forecast availability, standardisation of supply, and economies of scale.[1] Meanwhile, in theory, both payers and vendors can experience simplified negotiation efforts and reduced administrative burden.

We welcome all initiatives that enhance patients access to medicine,” says Simon Estcourt, Managing Director, Abacus Medicine Pharma Services. “Equitable access to innovative medicines at affordable prices and continuity of supply are both important and fundamental issues which affect patients access to medicine. The initiatives from NFP and BeNeLuxA will help secure access to treatments for the patients represented by these alliances. As a service provider, that has a focus on both of these regions, we will continue to work with payers and help the pharmaceutical industry navigate these markets, supporting the effort to bring more equitable access to medicine to underrepresented populations.

Abacus Medicine Pharma Services (AMPS) is a strategic partner to pharmaceutical companies launching and distributing medicines in Europe. Thanks to its parent company Abacus Medicine, AMPS combines a strong pan-European distribution network with expertise in market access, commercial strategy, medical affairs, supply chain management, and compliance, to help maximise patient access to speciality medicines.

Based in Copenhagen and with robust distribution networks across the Nordics and Benelux, the company is the perfect partner for pharmaceutical companies looking to take advantage of the regions’ attractive, collaborative market conditions.