# A joint price negotiation bloc for middle-income countries, modelled on Beneluxa

Source: https://onco.cc/ideas/idea-reg-middle-income-negotiation-bloc/  
OnCo record `idea-reg-middle-income-negotiation-bloc` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Small European countries have started negotiating cancer drug prices together. A bloc of large middle-income countries would have far more bargaining power.

## Summary

Beneluxa, the Nordic Pharmaceutical Forum and the Valletta Declaration group pool HTA and negotiation among European countries with modest results but proof of feasibility. Middle-income countries (Brazil, Mexico, Colombia, South Africa, Indonesia, Thailand, Egypt and others) negotiate alone and often pay list prices comparable to high-income countries for oncology drugs. The proposal is a formal negotiation bloc with a shared HTA secretariat, common evidence dossiers, and joint tenders or price agreements for new oncology medicines, backed by the PAHO Strategic Fund model for procurement.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Bloc members achieve net prices for new oncology medicines at least 30% below what they paid individually for comparable launches, and time from approval to public availability falls.
- Rationale: Bargaining power scales with volume and with credible willingness to walk away; a bloc of several hundred million people can offer both, and a shared HTA cuts each member's assessment costs.
- Proposed test: Convene five middle-income countries to run three joint negotiations for new oncology medicines over two years and compare achieved prices with prior individual agreements for similar products.
- Maturity: speculative
- Actor: policy

## Sources

- Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017): https://doi.org/10.1038/nrclinonc.2017.31

## Connected records

- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [Prices and value](https://onco.cc/bottlenecks/b-drug-pricing/)
- key papers: [The high price of anticancer drugs: origins, implications, barriers, solutions](https://onco.cc/key-papers/paper-prasad-nat-rev-clin-oncol/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/)

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