The Beneluxa initiative

In the Beneluxa initiative, Belgium, the Netherlands, Luxembourg, Austria and Ireland are working together on making new, innovative medicinal products available more quickly for patients in those countries. This international collaboration focuses on carrying out price negotiations jointly with pharmaceutical companies. Because these 5 countries are working together, more patients are represented than by any of the countries individually. The underlying logic is that the more patients are represented, the more of a say there is in the negotiations about expensive, innovative medicinal products.

Broad collaboration

International collaboration allows the access to expensive medicinal products to be guaranteed better for the patients. The collaboration is not solely about joint price negotiations. The countries are also examining what innovative medicinal products – which are also often extremely expensive – are due to appear in the near future; this is referred to as ‘horizon scanning’. The countries also exchange information about their medicinal product policy (such as insured package advice) and about the assessment of innovative care technology. Greater transparency about costs and pricing is also on the agenda. Cooperating more in these areas will make it easier to negotiate jointly with pharmaceutical companies about the prices of medicinal products.

Why is Beneluxa needed?

Innovative medicinal products that are now appearing on the market can improve the quality of life for many people. New medicinal products are sometimes able to cure patients successfully. They are however often complex or only work for a small group of severely sick people. On top of that, these medicinal products are often extremely expensive. As a result, the affordability of care can be threatened if those medicinal products are admitted automatically to the basic health insurance package. This can in turn lead to less good and less affordable care for other patients. These countries therefore want innovative medicinal products to be offered at a realistic price.

What the countries also want is for better care to be made available as quickly as possible for the patients who need it. Collaboration in this regard can play an important role.

What does Beneluxa do?

Beneluxa is a voluntary collaboration of countries within the European Union. This is because the reimbursement of medicinal products is not something that the European Union as a whole is authorised to do.

Price negotiations

The 5 countries involved work together during price negotiations with pharmaceutical companies. The underlying logic of the Beneluxa initiative is that the more patients are represented, the more of a say there will be in the negotiations about expensive, innovative medicinal products.

That collaboration ensures not only a stronger negotiating position but also helps strengthen the demand for greater transparency about the costs of pharmaceutical products.

Horizon scanning

The countries collaborate on studies into which innovative, expensive medicinal products are going to appear on the market; this is known as ‘horizon scanning’. Getting informed early about which medicinal products and technologies are in the pipeline lets us anticipate at an earlier stage whether certain items should be reimbursed through the health insurance package and agreements can then be made about the pricing. These medicines can then be made available as quickly as possible for patients in these 5 countries.

See the page 'Horizon Scan for Medicinal Products' for more information.

Joint assessments

For some dossiers, there is also collaboration to spread the tasks. It may then for instance be possible that once country will take the lead in assessing the effectiveness of a medicinal product while another looks at the justification for the pricing. The input from each country can then be pooled to allow each to make its own decision about whether the medicinal product should be reimbursed from the public purse. The countries then examine whether they can carry out the price negotiations jointly.

What is the purpose of Beneluxa?

In summary, Beneluxa aims for the following:

To anticipate national healthcare challenges by obtaining a picture at an early stage of new pharmaceutical products that will be appearing on the market and of new indications for existing medicinal products (known as ‘horizon scans’).
To improve the efficiency of the processes for licensing, price determination and reimbursement of medicinal products by exchanging expertise and by collaborating on the assessments.
To share policy expertise and best practices with each other.
Transparency about prices and agreements.
In the longer term: collaboration with as many other countries as possible that are interested.

Which organisations are working together within Beneluxa?

The initial collaboration between Belgium and the Netherlands began in 2015. Luxembourg joined in later that same year. Austria joined at the beginning of 2016 too. Since then, the initiative has gone under the name Beneluxa, an abbreviation for the four participating countries. Ireland became the fifth country to join in 2018. Each country has its own system for the setup and reimbursement of care.

Belgium: Rijksinstituut voor Ziekte- en Invaliditeitsverzekering (RIZIV, the National Institute for Health and Invalidity Insurance)
Netherlands: National Health Care Institute
Luxembourg: Le Ministre de la Santé (Ministry of Health)
Austria: Dachverband der österreichischen Sozialversicherungen (DVSV, Federation of Austrian Social Insurers)
Ireland: The National Centre for Pharmacoeconomics (NCPE)