{"entity":{"id":"idea-reg-middle-income-negotiation-bloc","kind":"idea","name":"A joint price negotiation bloc for middle-income countries, modelled on Beneluxa","aka":[],"tldr":"Small European countries have started negotiating cancer drug prices together. A bloc of large middle-income countries would have far more bargaining power.","summary":"Beneluxa, the Nordic Pharmaceutical Forum and the Valletta Declaration group pool HTA and negotiation among European countries with modest results but proof of feasibility. Middle-income countries (Brazil, Mexico, Colombia, South Africa, Indonesia, Thailand, Egypt and others) negotiate alone and often pay list prices comparable to high-income countries for oncology drugs. The proposal is a formal negotiation bloc with a shared HTA secretariat, common evidence dossiers, and joint tenders or price agreements for new oncology medicines, backed by the PAHO Strategic Fund model for procurement.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Prices and value): Prasad, De Jesús & Mailankody, The high price of anticancer drugs: origins, implications, barriers, solutions (Nat Rev Clin Oncol 2017)","url":"https://doi.org/10.1038/nrclinonc.2017.31"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-global-access"],"keyPapers":["paper-prasad-nat-rev-clin-oncol"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Bloc members achieve net prices for new oncology medicines at least 30% below what they paid individually for comparable launches, and time from approval to public availability falls.","rationale":"Bargaining power scales with volume and with credible willingness to walk away; a bloc of several hundred million people can offer both, and a shared HTA cuts each member's assessment costs.","test":"Convene five middle-income countries to run three joint negotiations for new oncology medicines over two years and compare achieved prices with prior individual agreements for similar products.","maturity":"speculative","actor":"policy","cost":"small","horizonYears":3},"route":"/ideas/idea-reg-middle-income-negotiation-bloc/","neighbours":{"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"}],"paper":[{"id":"paper-prasad-nat-rev-clin-oncol","kind":"paper","name":"The high price of anticancer drugs: origins, implications, barriers, solutions","route":"/key-papers/paper-prasad-nat-rev-clin-oncol/"}],"roadmap":[{"id":"global-access-roadmap","kind":"roadmap","name":"Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation","route":"/roadmaps/global-access-roadmap/"}]}}