EUROHEALTH

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Ensuring eeuitable access to cost-effective medicines and technology
anatomical therapeutic chemical -ATCcode).
This involves price volume
agreements whereby prices decrease as
volume increase and all discounts are
confidential. These agreements can be
terminated with three months’ notice,
which can then be used in the case of
parallel imports.
Assessing expensive medicines
Another important initiative in Denmark
that has benefited the centralized
procurement work of Amgros is the
Danish Council for the Use of Expensive
Hospital Medicines (RADS council),
established in 2010. The RADS council
consists of representatives from each
region, the National Health Board,
the Danish Association of Clinical
Pharmacology and the Patients’
Association. The Council’s objective is
to ensure that all patients have access
to the best possible treatment no matter
where they live and which hospital they
visit. To achieve this, the RADS council
set up smaller professional councils
consisting of leading experts within the
different specialties. Each professional
council evaluates the clinical benefits
of expensive medicines that have been
selected for evaluation. The evaluation
is based on dossiers submitted by the
industry and an analysis of the literature
of the therapeutic area. RADS uses the
Grading of Recommendations Assessment
(GRADE) methodology ‡ . After a thorough
assessment, the professional council
publishes recommendations for treatment.
Amgros uses these recommendations for
treatment to determine which medicines it
will hold tenders for. The RADS council
then prepares a priority list showing which
generic substances hospitals should choose
first, then second and so forth. After the
tender, the recommendation includes the
name of products.
The results of the tender are used
to establish a list of medicines that
hospitals should use for the treatment in
question. The winner of the tender and
their product is ranked first on the list
which prescribers will then use unless
they have a justification not to. It is
important to underline that physicians
maintain their prescription authority.
‡ http://www.gradeworkinggroup.org/index.htm
The system was originally received
negatively as not respecting physician’s
autonomy. Over time, however, many
physicians have started to regard the
system as helpful § , and instead now see
the treatment recommendations as a useful
tool for decision making; the system is
also reported to alleviate physicians’
workloads.
Prioritizing quality
The RADS council has made it possible
for Amgros to negotiate better prices.
While an evaluation of the process to
assess cost savings from engaging the
RADS council is still pending and will
depend on hospitals’ implementation of
the tool, what is clear is that the RADS
process has improved quality of treatment
in Denmark. 1 Preliminary estimates
suggest that the RADS council and its
recommendations has given the country
€42 million added value at an expense of
approximately €22 million since 2010. 1
Prioritizing cost-effective processes
Over the 25 years that Amgros has
existed, billions of Euros have been saved
for Danish public hospitals. 1 Although
the objective remains the same- to save
costs in pharmaceutical procurement –
Amgros has become more than a trading
company. In addition to ensuring savings,
Amgros has been able to promote safety
and quality of medicines used in hospitals
across Denmark and has also engaged in
research and development activities by
promoting research collaborations with
hospital pharmacies. It also provides
administrative support to hospital
pharmacies, allowing them to focus more
on patient care and their core tasks.
Trading has been made easier for
both suppliers and customers through
Amgros. The specially tailored tender
and Enterprise Resource Planning (ERP)
systems support the business processes
for hospital pharmacies, hearing clinics
and suppliers. Hospital pharmacies and
hearing clinics achieve considerable
administrative savings by having Amgros
organize supply, and fully integrating
order management systems. The efficient
§ This assessment is based on feedback from the RADS
Secretary General.
ERP systems also mean that Amgros
does not have to manage and run stocks
of medicines. Hospital pharmacies order
drugs directly from the supplier-once
approved through the tender processthrough
an online ERP system.
of Euros have
been saved
‘‘billions
As a purchaser Amgros is constantly
on the lookout for cheaper alternatives
to existing medicines that are also of
equivalent quality. Pharmacists in its
tendering unit are employed to scan
the market, make decisions about new
products and explore possibilities for
substitution or parallel import. Suppliers
can benefit from the unique internetbased
tendering system, which ensures
easy workflows, transparency and
equal treatment for everyone submitting
a tender.
Next steps
Amgros will continue to play an important
role in the centralized procurement
for hospital medicines in Denmark. It
continues to meet the regions’ expectations
and reduces costs by working in close
and constructive dialogue with all
stakeholders. Amgros is driving an
efficient business when it comes to buying
pharmaceuticals. Centralized procurement
has resulted in savings for Denmark and
Amgros is now working on becoming a
strategic procurement business partner.
Being a strategic partner means being
able to forecast market trends but also
scanning the market for new products and
innovations, known as horizon scanning.
References
1
Internal data, Department of Business Analysis,
Amgros.
2
KPMG. External Analysis of Pharmaceutical
Procurement of Amgros. Copenhagen: Denmark,
2014. Available in Danish upon request.
Eurohealth — Vol.22 | No.2 | 2016