Skip to main content
SpringerLink
Log in

Centralised Pharmaceutical Procurement: Learnings from Six European Countries

  • Practical Application
  • Published:
Applied Health Economics and Health Policy Aims and scope Submit manuscript

Abstract

Several European countries have introduced centralised procurement for all or some medicines. This article comparatively describes key features of national centralised pharmaceutical procurement (CPP) systems of six European countries (Cyprus, Denmark, Estonia, Italy, Norway and Portugal). Additionally, it aims to identify benefits, challenges and prerequisites for successful CPP, with a view to offering learnings for other countries. Information was collected based on literature and interviews with national procurement experts. While all countries studied established a designated procurement entity, other institutional and organisational features of the CPP systems vary across the countries. All CPP systems apply a mix of procurement procedures depending on the type of medicine (mainly tendering and negotiations). Reported benefits of CPP include lower purchase prices, stronger bargaining power of the public purchasers, enhanced transparency and governance, improved equity, and eventually improved access to medicines. Challenges that are to be met particularly in the starting phase are opposition of some users and the management of stakeholders with different expectations. Issues such as limited competition and non-availability of medicines may continue in the CPP setting. Compliance with good procurement principles is indispensable for any procurement, including CPP. Further prerequisites for successful CPP include a consistent, comprehensive and regularly updated procurement strategy, sufficient funding and appropriate staffing of the procurement entity, efficient processes including contract management and logistics, data collection and monitoring as well as interaction with users and suppliers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vogler S, Paris V, Ferrario A, Wirtz VJ, de Joncheere K, Schneider P, et al. How can pricing and reimbursement policies improve affordable access to medicines? Lessons learned from European countries. Appl Health Econ Health Policy. 2017;15:307–14.

    Article  Google Scholar 

  2. Wettstein DJ, Boes S. Effectiveness of national pricing policies for patent-protected pharmaceuticals in the OECD: a systematic literature review. Appl Health Econ Health Policy. 2018;17(2):143–62.

    Article  Google Scholar 

  3. Wettermark B, Godman B, Jacobsson B, Haaijer-Ruskamp FM. Soft regulations in pharmaceutical policy making. Appl Health Econ Health Policy. 2009;7(3):137–47.

    Article  Google Scholar 

  4. Vogler S, Paris V, Panteli D. Ensuring access to medicines: How to redesign pricing, reimbursement and procurement? European observatory on health care systems. Copenhagen: WHO Regional Office for Europe. 2018. http://www.euro.who.int/__data/assets/pdf_file/0009/379710/PolicyBrief_AUSTRIA_PB30_web_13082018.pdf. Accessed 25 Oct 2021

  5. WHO Europe. Challenges and opportunities in improving access to medicines through efficient public procurement in the WHO European Region. Copenhagen: World Health Organization Regional Office for Europe. 2016. http://www.euro.who.int/__data/assets/pdf_file/0003/323598/Challenges-opportunities-improving-access-medicines-efficient-public-procurement.pdf?ua=1. Accessed 20 Aug 2020

  6. European Commission. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. Pharmaceutical Strategy for Europe. COM/2020/761 final. 25 November 2020. Brussels. 2020. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:52020DC0761. Accessed 17 Jan 2021

  7. European Commission. Public Procurement in Healthcare Systems. Opinion of the Expert Panel on effective ways of investing in Health (EXPH). Brussels. 2021. https://op.europa.eu/en/publication-detail/-/publication/0fa5efff-b138-11eb-8307-01aa75ed71a1/language-en. Accessed 7 Aug 2021

  8. European Commission. Directive 2014/24/EU of the European Parliament and of the Council of 26 February 2014 on public procurement and repealing Directive 2004/18/EC. Brussels. 2014. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:02014L0024-20180101. Accessed 3 Jan 2022

  9. European Commission. Public tendering rules. Brussels. 2021. https://europa.eu/youreurope/business/selling-in-eu/public-contracts/public-tendering-rules/index_en.htm. Accessed 3 Jan 2022

  10. Maniadakis N, Holtorf A-P, Corrêa JO, Gialama F, Wijaya K. Shaping pharmaceutical tenders for effectiveness and sustainability in countries with expanding healthcare coverage. Appl Health Econ Health Policy. 2018;16(5):591–607.

    Article  Google Scholar 

  11. PAHO. Access to high-cost medicines in the americas situation, challenges and perspectives. Washington D.C: Pan American Health Organization. 2010. https://www.paho.org/hq/dmdocuments/2010/High-cost-Med-Tech-Series-No-1-Sep-15-10.pdf. Accessed 20 Aug 2020

  12. Hasan RSI, Lessing C. Pharmaceutical pricing policies in the Gulf Countries’ Council (GCC) and the United Arab Emirates (UAE). In: Pharmaceutical prices in the 21st century. Springer; 2015. p. 297–307.

    Google Scholar 

  13. Vogler S, Haasis MA, van den Ham R, Suleman F, Humbert T, Garner S. Cross-Country Collaborations to improve access to medicines and vaccines in the WHO European Region. Word Health Organization Regional Office for Europe. 2020. https://apps.who.int/iris/bitstream/handle/10665/332933/9789289055031-eng.pdf. Accessed 16 July 2020

  14. Seidman G, Atun R. Do changes to supply chains and procurement processes yield cost savings and improve availability of pharmaceuticals, vaccines or health products? A systematic review of evidence from low-income and middle-income countries. BMJ Glob Health. 2017;2(2): e000243.

    Article  Google Scholar 

  15. Wouters OJ, Sandberg DM, Pillay A, Kanavos PG. The impact of pharmaceutical tendering on prices and market concentration in South Africa over a 14-year period. Soc Sci Med. 2019;220:362–70.

    Article  Google Scholar 

  16. Barbosa K, Fiuza EPS. Demand aggregation and credit risk effects in pooled procurement: evidence from the Brazilian public purchases of pharmaceuticals and medical supplies. In: FGV EESP—Textos para Discussão/working paper series. 2012.

  17. Callea G, Armeni P, Marsilio M, Jommi C, Tarricone R. The impact of HTA and procurement practices on the selection and prices of medical devices. Soc Sci Med. 2017;174:89–95.

    Article  Google Scholar 

  18. Toulemon L. The effect of group purchasing on prices hospitals pay for medicines. Health Econ. 2018;27(9):1380–93.

  19. Dubois P, Lefouili Y, Straub S. Pooled procurement of drugs in low and middle income countries. European Econ Rev. 2021;132:103655.

  20. Castro VA, Centeno BL, Palacios JP, Casasempere IM, Martin AG, Oyarzabal AA, et al. 2SPD-027 Centralised purchasing as a strategic line for the rationalisation of pharmaceutical expenditure in a regional health service. Eur J Hosp Pharm. 2018;25(Suppl 1):A21–2.

    PubMed Central  Google Scholar 

  21. Sigulem F, Zucchi P. E-procurement in the Brazilian healthcare system: the impact of joint drug purchases by a hospital network. Rev Panam Salud Publica. 2009;26:429–34.

    PubMed  Google Scholar 

  22. Huff-Rousselle M. The logical underpinnings and benefits of pooled pharmaceutical procurement: a pragmatic role for our public institutions? Soc Sci Med. 2012;75(9):1572–80.

    Article  Google Scholar 

  23. Vogler S, Habimana K, Bauert E, Schneider P, Haasis MA. Assessment of centralised procurement of medicines in Portugal. Vienna: Gesundheit Österreich. 2021. https://ppri.goeg.at/sites/ppri.goeg.at/files/inline-files/GOe_FP_PT_CPM_Full%20Report_total_bf.pdf. Accessed 28 Aug 2021

  24. Vogler S, Habl C, Leopold C, Mazag J, Morak S, Zimmermann N. PHIS hospital pharma report. Vienna: Pharmaceutical Health Information System (PHIS); 2010.

    Google Scholar 

  25. WHO. Monitoring the components and predictors of access to medicines. World Health Organization. Delhi. 2019. https://www.who.int/medicines/areas/policy/monitoring/monitoring-the-components-of-access-to-medicines.pdf?ua=1. Accessed 28 Apr 2020

  26. OECD. Methodology for assessing procurement systems (MAPS). Paris: Organisation for Co-operation and Development. 2018. http://www.mapsinitiative.org/methodology/MAPS-methodology-for-assessing-procurement-systems.pdf. Accessed 21 Oct 2019

  27. WHO. Measuring Transparency in the Public Pharmaceutical Sector. Assessment Instrument. World Health Organization. Geneva. 2009. https://www.who.int/medicines/areas/policy/goodgovernance/AssessmentInstrumentMeastranspENG.PDF?ua=1. Accessed 28 Apr 2020

  28. Petrou P, Talias MA. Tendering for pharmaceuticals as a reimbursement tool in the cyprus public health sector. Health Policy Technol. 2014;3(3):167–75.

    Article  Google Scholar 

  29. Petrou P, Talias MA. Price determinants of the tendering process for pharmaceuticals in the cyprus market. Value Health Reg Issues. 2015;7C:67–73.

    Article  Google Scholar 

  30. Panayiotopoulou EA, Charalambous G, Kaitelidou D, Jelastopulu E. Assessment of effectiveness of tendering procedure in pharmaceuticals: the Cyprus experience. Ann Pharmacol Pharm. 2020;5(2):1179.

    Google Scholar 

  31. Bartels D. Centralizing procurement of medicines to save costs for Denmark. Eurohealth. 2016;22(2):42–3.

    Google Scholar 

  32. Ferrario A, Humbert T, Kanavos P, Pedersen HB. Strategic procurement and international collaboration to improve access to medicines. Bull World Health Organ. 2017;95(10):720.

    Article  Google Scholar 

  33. Mack A. Norway, biosimilars in different funding systems. What works? Generics Biosimilars Initiat J. 2015;4(2):90–2.

    Article  Google Scholar 

  34. SPMS. Relatório de Aferição de Poupanças de 2016. Lisboa: Serviços Partilhados do Ministério da Saúde (SPMS); 2017.

    Google Scholar 

  35. SPMS. Relatório de Aferição de Poupanças de 2017. Lisboa: Serviços Partilhados do Ministério da Saúde (SPMS); 2018.

    Google Scholar 

  36. SPMS. Relatório Aferição de Poupanças 2018. Lisboa: Serviços Partilhados do Ministério da Saúde; 2019.

    Google Scholar 

  37. Kohler JC, Mitsakakis N, Saadat F, Byng D, Martinez MG. Does pharmaceutical pricing transparency matter? Examining Brazil’s Public Procurement System. Global Health. 2015;11(1):34.

    Article  Google Scholar 

  38. Al-Abbadi I, Qawwas A, Jaafreh M, Abosamen T, Saket M. One-year assessment of joint procurement of pharmaceuticals in the public health sector in Jordan. Clin Ther. 2009;31(6):1335–44.

    Article  Google Scholar 

  39. Vončina L, Sagan A. New joint hospital procurement programme in Croatia. Eurohealth. 2014;20(2):29–32.

    Google Scholar 

  40. Sommersguter-Reichmann M, Wild C, Stepan A, Reichmann G, Fried A. Individual and institutional corruption in European and US Healthcare: overview and link of various corruption typologies. Appl Health Econ Health Policy. 2018;16:1–14.

    Article  Google Scholar 

  41. Chertes A, Crişan O. Standards for good pharmacy practice–a comparative analysis. FARMACIA. 2019;67(3):545–50.

    Article  Google Scholar 

  42. Repubblica Italiana. Legge 11 dicembre 2016. n. 232. Bilancio di previsione dello Stato per l'anno finanziario 2017 e bilancio pluriennale per il triennio 2017–2019. (16G00242). Roma. 2016. https://www.trovanorme.salute.gov.it/norme/dettaglioAtto?id=57356&completo=true. Accessed 5 Jan 2022

  43. Vogler S, Haasis MA, van den Ham R, Humbert T, Garner S. European collaborations on medicine and vaccine procurement. Bull World Health Organ. 2021;99(10):715–21.

    Article  Google Scholar 

  44. Amgros. All the agreements in the first joint Nordic tendering procedure are in place. Copenhagen. 2020. https://amgros.dk/en/knowledge-and-analyses/articles/all-the-agreements-in-the-first-joint-nordic-tendering-procedure-are-in-place/. Accessed 15 July 2020

  45. WHO. Operational principles for good pharmaceutical procurement. Geneva: World Health Organization. 1999. https://www.who.int/3by5/en/who-edm-par-99-5.pdf. Accessed 2 Aug 2021

  46. Kanavos P. Tender systems for outpatient pharmaceuticals in the European Union: evidence from the Netherlands and Germany. European Medicines Information Network (EMINet), 2012. https://silo.tips/download/tender-systems-for-outpatient-pharmaceuticals-in-the-european-union-evidence-fro. Accessed 23 Apr 2022.

  47. Kanavos P, Seeley L, Vandoros S. Tender systems for outpatient pharmaceuticals in the European Union: evidence from the Netherlands, Germany and Belgium. European Medicines Information Network (EMINet), 2009. https://ppri.goeg.at/sites/ppri.goeg.at/files/inline-files/EMINet_Report%20on%20Preference%20Policy%20and%20Rebate%20PolicyFINAL_1.pdf. Accessed 23 Apr 2022.

  48. Dylst P, Vulto A, Simoens S. Tendering for outpatient prescription pharmaceuticals: What can be learned from current practices in Europe? Health Policy. 2011;101(2):146–52.

    Article  Google Scholar 

  49. Vogler S, Gombocz M, Zimmermann N. Tendering for off-patent outpatient medicines: lessons learned from experiences in Belgium, Denmark and the Netherlands. J Pharm Health Serv Res. 2017;8:147–58.

    Article  Google Scholar 

Download references

Acknowledgements

The authors sincerely thank Manuel Alexander Haasis and Peter Schneider of the Austrian National Public Health Institute, who contributed to this study by participating in some interviews, which served as key information source for this paper. Furthermore, the authors are grateful to the country experts who were available for interviews and shared important insights (listed in the electronic supplementary material, Supplementary Information SI 3).

Author information

Authors and Affiliations

  1. WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies, Pharmacoeconomics Department, Gesundheit Österreich GmbH (Austrian National Public Health Institute/GÖG), Vienna, Austria

    Sabine Vogler & Katharina Habimana

  2. Pharmaceuticals and Medical Devices Department, Estonian Health Insurance Fund, Tallin, Estonia

    Eveli Bauer

Authors
  1. Sabine Vogler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eveli Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katharina Habimana
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sabine Vogler.

Ethics declarations

Funding

The study was carried out with funding by the European Union via the Structural Reform Support Programme and in cooperation with the Directorate-General for Structural Reform Support of the European Commission (Service Contract No. SRSS/C2019/034). No funding was received for the writing of this article.

Conflict of interest

The authors declare no conflict of interest.

Ethics statement

The study received approval of the Ethical Committee of the NOVA Medical School in Lisbon.

Consent to participate

Informed consent was obtained from all interviewees in writing (see Supplementary Information SI 2 in the electronic supplementary material for the Informed Consent Form).

Consent to publish

All interviewees consented to the publication of the study.

Availability of data and material

All data generated or analysed during this study are included in this published article and its supplementary information files (in particular in SI 3).

Code availability

Not applicable.

Author contributions

SV, EB and KH designed the research. SV and KH did the literature review, and SV, EB and KH participated in the interviews and documented them (interviews were normally conducted by two researchers—the authors and/or further researchers mentioned in the acknowledgements). SV, EB and KH were involved in writing draft country summaries (which served as the basis for the descriptions and analyses provided in the Supplementary Information; see the electronic supplementary material). SV wrote a first draft of the article and revised it after comments from EB and KH.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vogler, S., Bauer, E. & Habimana, K. Centralised Pharmaceutical Procurement: Learnings from Six European Countries. Appl Health Econ Health Policy 20, 637–650 (2022). https://doi.org/10.1007/s40258-022-00729-w

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40258-022-00729-w

Search

Navigation