Cross-border collaboration plays a crucial role in improving access to medicines and managing costs. These initiatives, ranging from regional to transcontinental efforts, address the challenges of drug pricing, procurement, and equitable access. In this Directors Digest, I discuss the significance of cross-border collaboration, its impact on healthcare economics, system dynamics, and policy implementation, with insights and recommendations for 2025.

Context and Background

Cross-border collaborations in healthcare aim to tackle escalating drug costs and ensure timely access to treatments. Historically, nations negotiated drug prices and procurement independently, often resulting in disparities in access and pricing. Cross-border initiatives reflects a shift towards collective action, leveraging shared resources and expertise to improve healthcare outcomes.

Key Analysis and Insights

Regional Cross-Border Collaborations

• Beneluxa Initiative: Focused on Advanced Therapy Medicinal Products (ATMPs), this initiative has negotiated prices for therapies like Libmeldy and Hemgenix. Despite challenges in reaching a consensus due to differences in national healthcare funding, Beneluxa’s efforts highlight the potential for enhanced collaboration.
• Nordic Pharmaceutical Forum and Joint Nordic HTA Bodies: Formed to address rising drug costs and supply issues, these groups engage in horizon scanning, joint HTA, and procurement. Their collaboration with Beneluxa and other groups highlights the importance of strategic and technical cooperation.

Pan-European Collaborations

• National Competent Authorities on Pricing and Reimbursement (NCAPR): Funded by EU4Health, NCAPR aims to enhance efficiency and affordability through shared best practices. The focus on transparency and innovative payment methods is crucial for addressing the complexities of drug pricing.
• Mechanism of Coordinated Access to Orphan Medicinal Products (MoCA): This initiative seeks to improve access to therapies for rare diseases by fostering dialogue between manufacturers, payers, and patient representatives. The success of MoCA in facilitating price concessions for faster access illustrates its potential impact.

Transcontinental Collaborations

• Project Orbis and Access Consortium: These initiatives, involving countries like Australia, Canada, and the US, focus on accelerating regulatory approvals for cancer and non-oncology drugs, respectively. Their efforts demonstrate the value of international cooperation in expediting access to critical therapies.
• UK International Recognition Framework: By recognizing marketing authorizations from other regulatory authorities, this framework facilitates quicker access to cutting-edge drugs, enhancing global market dynamics.

Implications and Recommendations

The findings from these collaborations suggest several implications for policy, health economics, and system dynamics:

• Policy Impact: Cross-border collaborations can lead to more equitable access to medicines, particularly for countries with lower purchasing power. The European Commission’s push for greater coordination in pricing and procurement highlights the need for supportive policy frameworks.
• Health Economics: By pooling resources and negotiating collectively, these initiatives can achieve lower drug prices and improve affordability. However, reaching a consensus on pricing remains challenging due to varying national interests and healthcare systems.
• System Dynamics: The success of these collaborations hinges on effective communication and alignment of objectives among participating countries. Strategic horizon scanning and joint HTA are critical for anticipating future needs and ensuring sustainable access to new therapies.

Recommendations for Decision-Makers:

• Strengthen existing frameworks like Beneluxa and NCAPR by fostering enhanced engagement and aligning national policies with collaborative goals.
• Utilise real-time data and advanced analytics to improve supply chain visibility and resilience, as emphasized by the Critical Medicines Alliance.
• Encourage transparency in pricing and procurement processes, and ensure that collaborative efforts address health equity considerations, as advocated by the Health Economics Methods Advisory group.

Conclusion

Cross-border collaboration is essential in addressing the global challenges of drug pricing and access. By fostering collective action and leveraging shared resources, these initiatives can lead to more equitable and timely access to medicines. As we approach 2025, it is imperative for decision-makers to enhance these mechanisms, promote transparency, and ensure that collaborative efforts align with the broader goals of health equity and system sustainability. The future of global healthcare depends on our ability to work together effectively, and the insights and strategies outlined here provide a roadmap for achieving this.

For further exploration of cross-border collaboration strategies, consider attending the World EPA Congress on 6th March 2025, where these topics will be discussed in depth. Additionally, staying informed about developments in EU pharmaceutical legislation and global health policy will be crucial for adapting to future changes in the healthcare landscape.

Sources

European Parliament (2021). Study on Cross-Country Collaborations on Medicines Pricing and Access. Available at: https://www.europarl.europa.eu/RegData/etudes/STUD/2021/690904/IPOL_STU(2021)690904_EN.pdf

EFPIA (European Federation of Pharmaceutical Industries and Associations). Policy Principles on Cross-Country Collaborations on Medicines Pricing and Access. Available at: https://www.efpia.eu/media/412513/policy-principles-on-cross-country-collaborations-on-medicines-pricing-and-access.pdf

WHO (World Health Organization) (2020). Cross-Country Collaborations on Medicines Pricing and Access Report. Available at: https://jasmin.goeg.at/id/eprint/1491/1/WHO_CrossCountryCollaborations_Report_2020.pdf

Rommel DW. Boosting cross-border collaborations and joint procurement to improve access to new medicines in Europe. Euractiv (2021) https://www.euractiv.com/section/health-consumers/opinion/boosting-cross-border-collaborations-and-joint-procurement-to-improve-access-to-new-medicines-in-europe/

Consulting, Neil Grubert. Implications of cross-border collaboration for pricing and procurement. World EPA Congress, 6 March 2025.

Lee KS, Ming LC, Lean QY, Yee SM, Patel R, Taha NA, Kassab YW. Cross-border Collaboration to Improve Access to Medicine: Association of Southeast Asian Nations Perspective. J Epidemiol Glob Health (2019) 9:93–97. doi: 10.2991/jegh.k.190506.001

Boosting cross-border cooperation for health: initiatives from Lower Austria. https://www.who.int/europe/news/item/21-10-2024-boosting-cross-border-cooperation-for-health–initiatives-from-lower-austria