Guidelines on collective procurement of prescription drugs: hospitals and health insurers can increase their clout

Purchasing agents of hospitals and health insurers can increase their clout by collectively purchasing prescription drugs for specialist medical care more often. If they do so, the Netherlands Authority for Consumers and Markets (ACM) believes that they are able to negotiate lower drug prices and better conditions. The competition rules offer room for collective procurement. This has been one of the conclusions that ACM draws in the final version of its ‘Guidelines on collective procurement of prescription drugs for specialist medical care.

In April, ACM released the draft version of these guidelines, and called on stakeholders to comment on said draft version. ACM also held several roundtable discussions with health insurers and hospitals to find out whether the guidelines contain sufficient directions for implementation in practice. ACM has now clarified several parts of the guidelines in the final version.

For example, several stakeholders wondered whether the guidelines also applied to collaborations that went beyond the procurement of drugs. That is not the case. If hospitals and health insurers develop additional plans that involve more than just procurement, for example about health care reimbursements or selective procurement of health care services (beyond drugs alone), they will have to make a separate assessment of whether or not those additional plans comply with antitrust rules.

ACM has additionally clarified that the guidelines will not have any effect on other, more care-related rights and obligations of hospitals, health insurers, and medical specialists.

Rules of thumbs for collective procurement

The guidelines explain what opportunities the competition rules offer, and what limits they set if hospitals or health insurers purchase drugs collectively. ACM list three rules of thumb in the guidelines. If purchasing agents follow these rules of thumb, ACM does not expect to see any problems for competition, which means the collective-procurement arrangement is allowed.

• Rule of thumb 1: The total costs of the drugs purchased collectively cannot comprise more than a limited share of the hospital costs.
• Rule of thumb 2: Other buyers must be able to join any group purchasing organization (or joint purchasing organization).
• Rule of thumb 3: It must be easy to leave a group purchasing organization (or joint purchasing organization).

It should be noted that, outside of these rules of thumb, cooperation between purchasing agents continues to be possible. In order to determine whether a specific collaboration complies with general antitrust rules, a more extensive analysis of the collaboration in question could be necessary.