Tendering for off-patent outpatient medicines: lessons learned from experiences in Belgium, Denmark and the Netherlands

Abstract

Objectives: To study the impact of tendering for off-patent outpatient medicines in terms of savings for payers and availability of medicines, to explore stakeholder perceptions and to elaborate prerequisites for a successful implementation of the policy. Methods: We selected three case studies (Belgium, Denmark and the Netherlands). Information was collected through literature review and stakeholder interviews. Key findings: The three case study countries used tendering in different designs. While Dutch health insurers have been tendering for off-patent medicines for more than a decade, Belgium applied this policy for only two substances in 2007/2008 and then stopped. Denmark has a kind of tendering practice: pharmaceutical companies have been submitting biweekly price bids for reimbursable outpatient medicines to the Medicines Agency since the mid-1990s. Stakeholder perception varies between the countries: generic industry, pharmacists and partially patients tend to oppose the tendering practice; in Denmark, however, the system is highly appreciated by all stakeholders. All three countries reported savings for public payers. Experiences related to availability limitations were mixed (Belgium – the winner of the second tender had no capacity to procure; Denmark – no indication of availability limitations; and the Netherlands – frequent medicine shortages, both for tendered and nontendered medicines). Conclusions: The findings suggest that tendering for off-patent medicines is able to contribute to cost-containment. However, as the policy possibly risks leading to availability limitations, it has to be strategically designed to avoid or at least deal with shortages through backup mechanisms. Further prerequisites for a successful introduction of tendering include a robust legal and organisational framework, an appropriate stakeholder management and demand-side policies to promote generic uptake.