Francis Arickx, country coordinator of Belgium for the Beneluxa Initiative, introduces the project and its mission to help shape a unified healthcare policy approach between its member countries through activities such as horizon scanning and health technology assessments.
Please begin by introducing the Beneluxa initiative and its mission.
The Beneluxa Initiative aims to ensure sustainable access to innovative medicine at an affordable cost for patients. During the informal meeting of European Ministers for Employment, Social Policy, Health and Consumer Affairs in Riga, Latvia, in April 2015, the health ministers of Belgium and the Netherlands announced their initiative to explore possible collaboration on pharmaceutical policy. This included price negotiations with pharmaceutical companies for orphan medicinal products. In September 2015, Luxembourg joined the Belgium-Netherlands project and Austria joined the cooperation initiative in June 2016. Since then this project has been named ‘Beneluxa’. In June 2018 Ireland also joined the Beneluxa initiative.
The initiative consists of a steering committee which oversees the overall collaboration, aided by technical domain task forces for each area of collaboration. The steering committee consists of representatives of each country and is complemented by the domain task force leaders. One of the collaborating countries is appointed as chair and organizational coordinator for Beneluxa for a certain period of time. This role is currently fulfilled by the Netherlands. Additionally, the leading country is assisted by national coordinators. They carry out the daily operations and prepare meetings, handle day-to-day issues and provide external communication.
What was the rationale for establishing Beneluxa?
Innovative therapies that are currently introduced to the market are of a different order than many new drugs over the past few decades. Increasingly often, new medicines are complex but successful, or for a small number of critically ill people. The quality of life of these patients can be dramatically improved and sometimes they can even be cured outright. In and of itself, this is excellent news.
However, the disadvantage is that these medications are extremely expensive. The emergence of these medications threatens the affordability of care and will detract from the care for other patients. Also, timely access of patients to medicines is hampered due to the current pharmaceutical system, in which the position of national governments is under pressure. This is partly caused by the variety in national policies on pricing, reimbursement and on the use of pharmaceuticals. At the same time, increasing pressure is put on the capabilities of individual authorities.
In order to change these developments, cooperation is essential. Beneluxa is a first collaborative step towards more balance in the pharmaceutical market. Our goal is to ensure timely access and affordability of medicines for our patients.
What are the areas of activity of Beneluxa and the initiatives current priorities?
Cooperation is needed to ensure patients’ access to expensive medicines. We cooperate in the fields of horizon scanning where the member countries work together to find out which innovative – often extremely expensive – medicines are about to become available in the near future.
Next on our list of priorities is information sharing and policy exchange. We exchange information on our medicine policies and believe that sharing information and collaboration between countries, over an extended period of time, will benefit policy initiatives on pricing and reimbursement of medicines.
Our third activity involves health technology assessment (HTA). Beneluxa members cooperate in HTA by using expertise acquired in the European Network on Health Technology Assessment (EUnetHTA) where we have a strong base for performing joint assessments.
Finally, our last activity is centred around pricing and reimbursement. By working closely together, it will be easier to negotiate medicine prices with the industry. Collaboration also allows us to demand more transparency on the cost build-up of pharmaceutical products. Also crucial for the improvement of medicine pricing is increased transparency on pricing between countries.
What have been the main achievements of Beneluxa thus far?
On 25 and 26 November 2019, the Beneluxa initiative held its steering committee meeting and general assembly and considered the progress made in the collaboration and the future work agenda. Technical experts have been collaborating to produce HTA reports; a common template for submission of a dossier and HTA reports has been developed and is ready to be piloted. In addition, the International Horizon Scanning Initiative (IHSI) was established as an independent legal entity last autumn and will be operationalized during this year. IHSI had been initiated by Beneluxa but is open to further countries to join – currently nine countries participate in IHSI. The Beneluxa representatives also discussed the concept of transparency, based on the earlier position of Beneluxa on transparency, and considered options of how to respond to the resolution on improving the transparency of markets for medicines, vaccines and other health products adapted by the World Health Assembly in May 2019 in an effort to expand access.
How will HTAs play an important role in the future of sustainability in healthcare?
The mutual recognition of national assessments would reduce the workload of national HTA-organizations and improve efficiencies for both the authorities and the industry. There are four types of HTA collaborations that are being studied in the Beneluxa initiative.
First is the re-use of HTA reports. In this case, countries use parts of HTA-reports of other countries to build similar reports locally.
Next is the joint writing of HTA reports. Authors from several countries join forces in order to write one report which can be used in all countries involved.
Third is the mutual recognition of HTA reports. In this case, large parts of, or even a full, HTA-report of one country are adopted by others in a parallel process. The results of the assessments are then published at the same time. This has not been carried out yet.
Finally, is external refereeing where HTA institutes of the various countries can also act as each other’s external referees in national procedures. It does not involve active work in a Health Technology Assessment itself.
What will be the key success factors of an initiative like Beneluxa?
Trust. Keeping the line of communication open among members and working in partnership will be crucial for achieving the collaborative environment of which Beneluxa is setting a precedent. Although it may be challenging to further grow the participating countries on Beneluxa, I hope that the body can act as a role model for the rest of Europe and showcase the opportunities that exist in creating a wider European network when it comes to facing the universal healthcare challenges that are present today.
