Collaborating for Affordable Patient Access to Medicines: Review of the First Decade of the Beneluxa Initiative in Pharmaceutical Policy.

Cross-country collaboration has been proposed as a policy solution to improve patient access to medicines. Since patient access to medicines at affordable costs has also become an issue for high-income countries, some European countries responded in 2015 by establishing the Beneluxa Initiative to work together in pharmaceutical policy. As of 2025, the Initiative comprised five countries (Austria, Belgium, Ireland, Luxembourg, and the Netherlands) and had ten years of experience in several joint collaborative activities, including horizon scanning, health technology assessment, reimbursement negotiations, and strategic exchange on policy developments. During its first decade, the Beneluxa Initiative conducted 15 joint health technology assessments and four joint negotiations. Insights gained through these collaborative processes have contributed to the refinement of methodological approaches and the exploration of new avenues, such as the establishment of the International Horizon Scanning Initiative with participation of additional countries. Although public attention often centres on joint negotiations, they represent only one dimension of the Initiative's work. The Beneluxa Initiative adopts a comprehensive product life-cycle approach, seeking to identify medicines with potentially high budget impact in early development stages, thereby allowing for timely preparation of collaborative assessments and negotiations. While differences in the legal and organisational national frameworks pose challenges and collaboration requires sufficient time resources, the Beneluxa experience demonstrated that collaboration in pharmaceutical policy across countries is possible and useful. Learnings can also be transferred to the global health policy community.