OnCo
ideasIdea

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

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

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.

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.
What would test it
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
Who has to act
policy
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks
  • Prices and value · New cancer drugs routinely cost over $150,000 a year, often for months of benefit. Systems cannot afford them and patients go bankrupt.
  • Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.

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