The Price of National Pharmaceutical Pricing in the EU: A Proposal for "Common Procurement".

Within the European Union (EU), pricing and reimbursement decisions for new medicines are the responsibility of individual Member States. The presence of many regulated prices for medicines within the EU single market drives strategic decisions by payers and manufacturers, resulting, among other things, in launch delays and unequal patient access across European countries. To increase equity in patient access, we propose strengthening collaboration on medicines procurement among Member States beyond emergency situations. Joint initiatives undertaken by groups of countries have demonstrated their potential to deliver benefits, and the need for common procurement initiatives has become apparent during the coronavirus disease 2019 (COVID-19) pandemic. We present our proposal within the context of the current European regulatory framework and the recently proposed "Critical Medicines Act", emphasising the key legislative provisions that can be invoked to support a common procurement initiative. We also provide relevant, actionable options for designing such initiatives. Strong political commitment and agreement on equity and solidarity principles would be needed for the successful implementation of the proposal.