06.12.2017 | Brussels Background Teaming up – Structured cooperation between Health Systems and the consequences for the Industry

Closer cooperation between Member States in the area of health systems seems to have become a very attractive thing, especially when it comes to pharmaceutical policies. The most prominent example may be BeNeLuxA, but other Member States are also teaming up. Might this development also offer chances to the pharmaceutical industry and can it even help to foster more sustainable health care in the future?

Back in 2016, the four EU Member States Belgium, the Netherlands, Luxemburg and Austria, decided to join forces and explore possible ways of cooperation on pharmaceutical policies. This project was christened BeNeLuxA and their aim was to jointly perform activities such as price negotiations with pharmaceuticals companies or so-called horizon scanning. Soon after this project was announced, others were to follow as for example Romania and Bulgaria, the Visegrad States plus Croatia and Lithuania (Visegrad +2). The latest edition of these cooperation models is the “Valetta Declaration” which has been signed in May 2017 under the Maltese Presidency, a strong advocate for more cooperation between Member States in the field of health care. Structured cooperation between health systems on pharmaceutical policies is also a topic at the EPSCO Council meeting in December. In a preparation note Estonia proposed to discuss options to even reinforce existing cooperation.   
But what’s behind this and what do Member States wish to achieve? Has there been some success yet? 
The first question is easy to answer: The Member States stress that joining their forces in negotiations, horizon scanning and possible collaboration in HTA leads to better access to medicines for patients. But underneath this honourable goal, lays the desire to reduce pharmaceutical prices at all cost. For some Member States it is a pure question of negotiation power, if they join forces with similar countries. They claim that the industry has a strategic information advantage as it is aware about the prices and discounts they provide in all countries leaving the industry with more leverage during the negotiations. 
The example of BeNeLuXa and its first joint negotiations with a pharmaceutical company shows that although Member States with comparable economic strength have similar goals, national legal requirements regarding reimbursement arrangements can still stand against successful negotiations. In some cases this could even lead to conflicts with national fiscal law or could lead to the applicability of European procurement law. These are all circumstances that need to be carefully assessed by the Member States involved. However, a loose and voluntary cooperation such as the Member States involved in the “Valetta Declaration” might be more successful.
Over the past few months, it appears like more and more Member States are really intrigued by this idea. More and more? Well, Germany is certainly not.  Germany is not and has never been a big fan of European involvement where there is supposed to be none according to the Treaties. And from this standpoint, health care is something that should be handled only on a national level. Stemming from its strong self-governing bodies of its healthcare system, Germany never grew tired of referring to the separation of competences between the European Commission and the Member States in that particular field. 
But is this perhaps a bit short-sighted? Is joining forces maybe something that could create a value for the Member States and the industry in the end leading to more sustainable health care systems? 
Certainly, stronger cooperation does have some advantages even for the industry. Take health technology assessments as an example. Recognizing the results of other Member States or even conducting joint assessments will reduce the bureaucratic burden for the pharmaceutical industry and set a standard for added value of medicines even globally. 
However, it is debatable whether joint price negotiations will have the desired effects. Of course, it is nice to dream about a European price for medicines as it has the potential benefit for industry to reduce the number of interlocutors and access the European market as a whole at once. But the current economic differences of Member States, the ability and willingness to pay for medicines, the reimbursement schemes often based on regional principles and quotas and the fact of parallel imports constitute enormous barriers for successful cooperation on pharmaceutical policies. 
Therefore, when talking about structured cooperation between health systems it is important to make the first step before the second and slowly integrate scientific methodologies rather than jumping to over-paced pricing negotiations.  Against this backdrop it is hard to understand why the health ministers’ council should address legal changes in order to reinforce structured cooperation between health systems, yet.