To tender or not to tender: a literature review and policy guidelines on tendering for outpatient generic pharmaceuticals

Nieto Rueda, Jorge

To tender or not to tender: a literature review and policy guidelines on tendering for outpatient generic pharmaceuticals

Citation

Nieto Rueda, J. To tender or not to tender: a literature review and policy guidelines on tendering for outpatient generic pharmaceuticals. 2022. handle: http://hdl.handle.net/10230/52563

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Abstract

Background: Despite progress in recent years, generic drugs markets are not developing its full potential, particularly in countries with more intense price regulation. Tendering is an alternative and indirect price setting scheme with great potential in achieving more efficient prices. However, its development has been scarce and controversial in outpatient settings. Objectives: To analyse whether and how tendering for outpatient generic pharmaceuticals in an EU country system could be a beneficial policy and to provide orientations on its key variables to policy-makers. Methods and search strategy: A literature review on outpatient generic tenders was conducted between 2011 and 2021 using PubMed and google scholar. The same search terms as a 2016 review by the WHO were used. In addition, aggregate and pool procurement of pharmaceuticals studies -not limited to outpatient settings- and public procurement and competition policy studies and documents from leading institution and scholars are also included in the analysis. Results: 12 studies from the literature review met the inclusion criteria. Tendering was overall a beneficial policy, with great potential for price reductions and for enhancing transparency. However, it is a complex policy interacting with a wide set of factors that should be considered: a) the legal, organisational and political framework; b) market and competition dynamics; c) stakeholders, as resistance is expected and are key on the policy implementation; d) tender design and implementation monitoring. Conclusion: Tendering is a powerful instrument but a complex one. A multidisciplinary approach should be followed while designing it. Risks of implementation gaps are substantial. There is no one-size-fits-all solution. However, balancing short-and long-term outcomes, favouring multiwinner schemes, ensuring a capable organisation and an appropriate framework, proper management of stakeholders and strengthening planning and implementation monitoring will be determinant for the success of a tender programme.