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As the pharmaceutical industry faces increasing pressure to integrate sustainability into their operations, the importance of alignment with international and national environmental guidelines becomes pivotal to gain a competitive edge in healthcare tenders.

Having visibility on tender award criteria per product and country is critical to be able to differentiate versus competitors and pro-actively discuss how to optimize tender settings and frameworks to improve attractiveness and sustainability of the market.

Furthermore, developing sustainable practice plans that support compliance and company goals, whilst ensuring they meet tender awarding criteria will enhance market position and differentiate products amongst competitors.

Although many European countries, such as Finland and Poland, still lack environmental sustainability criteria in their tendering processes, and others like Estonia, Lithuania, Portugal, Slovakia, and Slovenia continue to rely solely on price as the main criteria for awarding tenders, numerous governments are beginning to prioritize environmental requirements in their healthcare tendering processes. ¹

The analysis performed by Cube RM also reveals this trend.

One clear example of the influence of environmental sustainability in tendering is the Net Zero Supplier Roadmap from NHS England, that started in 2022 with the requirement that all NHS procurements needed to include a minimum 10% net zero and social value weighting.

The plan, extending beyond 2030, establishes that suppliers will only be able to qualify for NHS contracts if they can demonstrate their progress through published progress reports and continued carbon emissions reporting. ¹⁷

As a result, one of the main challenges pharmaceutical companies face is balancing the increasingly important environmental sustainability practices with the need to remain competitive, especially when price is still the primary criterion for awarding contracts.

Incorporating environmental sustainability into companies’ processes can be a significant undertaking. It requires a comprehensive approach, including changes in manufacturing, supply chain management, and product design. Many of these changes are heavily regulated and resource-intensive, often taking a considerable amount of time to be approved and implemented. However, in the long term, there are numerous benefits that can encourage pharmaceutical companies to go green:

• While implementing sustainable practices may involve initial costs, it can lead to long-term savings. Companies that invest in green technologies, energy efficiency, and waste reduction can reduce operational costs, making their bids more competitive.
• Demonstrating a commitment to environmental sustainability enhances a company’s reputation and builds trust with stakeholders, including healthcare providers, patients, and regulators. This positive perception can influence tender decisions in favour of companies perceived as responsible and forward-thinking.

The importance of environmental sustainability in the pharmaceutical industry cannot be overstated. As the industry continues to grow, its environmental footprint also expands, contributing to pollution and resource depletion.

From the raw material extraction, to manufacturing processes, global distribution, and eventual disposal⁶, the pharmaceutical industry is responsible for generating approximately 52 megatons of CO2⁷ annually – an amount exceeding the emissions of the automotive sector in nations like the UK.

As concerns about climate change, ecosystem protection, and human health continue to rise, numerous frameworks have highlighted the numerous frameworks have highlighted the need to address the environmental impact of the healthcare sector, including the Paris Agreement8, the UN’s Sustainable Development Goals (SDG)⁹, and the Greenhouse Gas Protocol¹⁰.

When analysing the main criteria in MEAT tenders, a combination of factors beyond price are used to evaluate tenders.

When analysing the data for the average weighting of the criteria used in awarded lots (Fig. 9), terms and conditions have now become the most recurrent criteria used, right after price.

Due to the supply and logistics issues caused by the Covid-19 pandemic plus some major stock-outs, also for Biosimilars, the importance of logistics, delivery, and supply in healthcare tendering has significantly increased5. Avoiding shortages of essential medicines and maintaining availability of supply to ensure treatment of critical populations continues to be paramount to patients’ health and to keep hospitals working smoothly.

Some other criteria, however, have seen a decline in importance. Packaging, quality, product technical features, and safety have all had a slight decrease in relevance as awarding criteria. Not surprisingly, social and environmental sustainability has shown a relative growth in importance since 2021.

Cube RM’s analysis of 16,845 awarded batches of top biosimilars across all European countries since 2021, conducted using proprietary and tender-specific, AI-based search algorithms that crawl multiple online tender sources worldwide, provides further evidence of these trends.

The data visualized within the Cube RM platform shows that price continues to be the most important criteria when awarding tenders. However, some evolution towards tender sustainability can be observed. For instance, when examining the use of price-only versus MEAT criteria by country cluster, some interesting patterns emerge.

Cluster 1
In Germany, France, the UK, Italy, and Spain, MEAT criteria are becoming increasingly important in tendering processes.

Cluster 2
In Denmark, Finland, Iceland, Norway, and Sweden, MEAT represents now the main tendering practice.

Cluster 3
In Czechia, Belgium, Ireland, Poland, and Portugal, some tenders are starting to follow MEAT criteria, however price-only tenders continue to be the norm.

Cluster 4
In Bulgaria, Croatia, Cyprus, Estonia, Hungary, Latvia, Lithuania, Luxembourg, Malta, Romania, Slovenia, and Slovakia, price-only tenders also continue to represent the majority of cases.

In Focus

Germany for many years, was a typical ‘price-only’ country, driven by big national insurance tenders. However, due to recent supply challenges and shortages, we can observe an inclusion of supply-criteria in tenders in 2024.

2025 presents the EU with an impending transformation — the implementation of the JCA process across all 27 member states. This harmonisation offers a remarkable opportunity to integrate patients and patient organisations into the JCA framework, not just as participants but as active collaborators in healthcare decision-making.

To leverage this opportunity to optimise patient engagement effectively, three key areas call for strategic consideration:

1. Empowering patients through education and resources:
   • Comprehensive training programs: Develop tailored educational initiatives to demystify the HTA process for patients.
   • Interactive workshops: Organise hands-on sessions to equip patients with the skills to contribute effectively.
2. Forging early collaborations with patients in product development:
   • Uncovering real-world needs: Involve patients at the earliest stages of product development to gain invaluable insights into their experiences and steer innovation accordingly.
   • Shaping value propositions: Align product profiles with patient preferences to address unmet patient needs and create compelling value propositions.
3. Ensuring transparency, impact and clarifying the role of patient voices:
   • Establishing funding mechanisms: Offer compensation for patient contributions to foster equitable involvement and mitigate financial barriers.
   • Communicating clearly: Articulate how patient input will be utilised and its influence on outcomes to build trust and ensure meaningful participation.
   • Implementing feedback loops: Create channels for patients to voice their perspectives on the process and its efficacy to drive continuous improvement.

By addressing these strategic considerations, healthcare stakeholders can foster meaningful patient involvement in HTAs, leading to more patient-centric healthcare decisions, improved outcomes, and a healthcare system that truly reflects the needs and values of the patients it serves.

As the EU moves towards the standardisation of the JCA process, it is crucial to ensure that patients and patient organisations are actively involved as co-architects of healthcare decision-making. Valid Insight stands ready to be your partner in navigating market access and patient engagement within the HTA and JCA processes.

Despite the widespread recognition of the importance of patient involvement in HTA, there is a lack of consensus on how to assess the quality of patient involvement.

Observing guidelines provides a systematic approach to assessing the quality of patient involvement in HTAs based on the following principles:

1. Transparency: The process of patient involvement should be transparent, with clear and accessible information about how patients are involved, what their role is, and how their input is used.
2. Accountability: Patients and patient organisations should assume responsibility for their involvement in HTAs, and mechanisms should be established to ensure accountability.
3. Inclusiveness: Efforts must be made to ensure that individuals from diverse backgrounds and with different experiences are involved.
4. Impact: Patient involvement should have a meaningful impact on the HTA process and the resulting decisions. This can be assessed by examining factors such as the degree of patient input reflected in the HTA report and the influence of patient involvement on the decision-making process.
5. Capacity building: Organisations representing patients and patient advocates should have the capacity to participate effectively in HTAs. This includes having the necessary skills, knowledge, and resources.
6. Sustainability: The involvement of patients in these processes should be sustainable, with mechanisms in place to ensure that they continue over time.

Ensuring high-quality patient engagement requires adhering to specific criteria and skills, where a transparent and meritbased selection process is crucial to identifying suitable patient advocates. Patient organisations often face resource constraints, emphasising the need for accessible training and support. Collaborative efforts can help bridge the resource gap and empower patient advocates to participate effectively in the JCA framework.