Table 1 Description of the recommendations with pros and cons

01

Transparency in the prices of sanitary technologies

Larger negotiating margins for countries

This would lead to the same price in the world that would produce iniquity

Promote integration between countries for the purchase of medicines and supplies

Trading limiting prices for small countries or countries with less bargaining power

Reduces corruption in drug purchases

-

It favors competition (when there are alternative products)

-

The prices would bear more relation with the costs

-

02

Efforts of the Ministry of Health and Executive to improve trade agreements and transparency in negotiating prices with the drugs’ and supplies’ industry.

Concentrate purchasing and trading with industry across the country

Discourages the industry to sell in that country

Define purchase prices for universal coverage

Impossibility for the industry to offer low prices to low-income countries

The price must adjust (principle of equity) to the economic possibilities of the countries

-

Do not purchase a drug without health technology assessment, budget impact and cost effectiveness

-

Ministries of health should participate in the negotiation of free trade agreements

-

03

Judiciary efforts to improve trade agreements and transparency in the negotiation of prices with the drugs’ and suplies’ industry

To interpret trade agreements in the light of the right to health of people and access to health information (including prices for the purchase of medicines)

This could cause negotiation problems for the Executive or the health authorities

Prevent the access, through justice, to the market of products or supplies that have not undergone the health evaluation or have incorporated health services.

04

Inclusion of the obligations assumed by the State as a counterpart of the discount on the price of the drug

The immediate discount on the price

Eliminate competition

Improvement of medication due to use of patient outcomes

Prevents the state from making an informed decision

05

Approve rules regulating this type of negotiations, requiring transparency and expressly stating that neither the price nor the other terms of the agreement can be confidential, except those protected by trade or industrial secrecy

-

Favors corruption because it is not transparent

06

Propose methodologies and train staff to address the price formation debate

-

Conditions public health policies

-

The use of the drug is improved without the patient having authorized the use of the results obtained by providing that medicine

07

Confidentiality agreements on the acquisition of sanitary technologies

The supposed fall in prices

Breaks the parameters of a joint trading policy

Access to the latest generation of drugs, which can not be accessed in any other way or by any other type of negotiation.

Lack of transparency

-

Blocks social control

-

It hinders and damages competition: there are no other suppliers

-

Another industry can’t present a better offer

-

There is no guarantee that the best price is being charged

-

Cross subsidies: the highest paid country can pay a part of the country that pays less

-

The industry ends up putting the rules of the game: the country enters the industry game