Interesting Nordic Collaboration Evolving in Market Access

Dag Larsson, Lif, Fotograf: Gunilla Lundström

“Interesting Nordic collaboration is evolving,” says Dag Larsson in this interview about the market access landscape in the Nordic countries. Dag Larsson is a senior policy expert at Lif, with many years of experience in pharma. Learn more about his views on country-specific challenges and his outlook for the future with novel treatments and a more restricted economy.

Market Access

In the pharma industry “Market Access” stands for all the efforts to get a new drug approved by authorities and covered by healthcare systems, so that patients can use them. This involves proving the drug’s value and setting its price as well as ensuring it meets all necessary regulations for patient access.

Although Denmark, Finland, Sweden and Norway are neighbouring countries with many similarities, there are also important differences between them when it comes to the journey to market access. I asked Dag Larsson about his experience in this area.

How do market access strategies differ among the Nordic countries?

“The Nordics are similar in the way that patients enjoy tax-based funding for the reimbursement of medicines. This means that access to the market either starts by the pharma company applying for reimbursement to the public service institution granting reimbursement or endorsing the use of a new product or by the Pricing and Reimbursement Agency’s request for evidence supporting the new medicines cost-effectiveness at the requested price”.

“Even though there are fundamental similarities across the markets, there are perhaps surprisingly significant differences how each country gets the work done. So, when you are embarking upon new medicine introduction in the Nordics you better gain full understanding of the ins and outs of each market”.

What about Nordic collaboration?

“We note interesting Nordic collaboration evolving. The countries have agreed on a shared platform named Joint Nordic HTA-Bodies or JNHA for short, where they will split the workload in the health economic assessment and eventually also have one combined negotiation for each new medicine. Since each national healthcare system is sovereign, any joint negotiation will have to be endorsed in each Nordic market”.

Economic impact on market access

Dag Larsson also notes that the ongoing economic downturn can be a greater challenge for health care providers in countries like the Nordics, with universal tax-based healthcare:

“Universal tax-based healthcare provision means that the providers face two sides of a general economic downturn. The tax base may be reduced and operational cost increase at the same time. Pharmaceutical spending is part of the latter and has been a relatively constant share of total healthcare spending. We note that societal willingness to pay is being discussed and various attempts to reduce cost are being considered”.

But he continues:
“At the same time, it is also so that with ageing and growing populations there is a growing underlying demand for medicines. According to TLV, for instance, Sweden enjoy among the lowest prices for generic medicines in Europe, still the segment growth is around 5% which is higher than Sweden’s central banks desired inflation rate of 2%.”

Policy and Regulatory Environment

Have you noticed any recent policy or regulatory changes affecting pharmaceutical market access in the Nordics?

“I don’t believe we in recent years have seen any policy or regulatory reforms that have made the introduction of medicines smoother. It remains to be seen if the JNHA and the European HTA regulation with joint clinical assessment delivers more effective access to the market in the countries and the even more important aspect of patients access to treatment with modern medicines.”

“If we look at the EFPIA WAIT report, our Nordic countries are somewhere in the middle of the countries in terms of number of products granted access and for hospital products the time to decision could be seen as unacceptable if we assume that many of the products has the potential to provide real value for patients”.

Impact of Novel Treatments

Advances in medicine are transforming the way we treat diseases, particularly with the rise of gene therapies and personalized medicine. These innovations offer groundbreaking possibilities, but they also challenge traditional models of market access and reimbursement. Many of these treatments come with high upfront costs, long-term benefits, and limited clinical data at the time of approval. This raises critical questions about how to assess their value, ensure affordability, and manage uncertainties.

In the Nordic countries, how are these treatments shaping market access and reimbursement?

”A lot of effort is being put into shaping an effective and mutually beneficial approach to access. Most of these are within the hospital medicine segment and the challenges can be summarized to lie within how to value the new, how to afford the new and how to address uncertainties in available data at the time of decision. Much of the health economics framework has evolved around medication for broader patient populations where available evidence is based on controlled randomized trials with statistically robust significant incremental benefit. This is not as easy when you for instance face a product that is a one-time treatment with expected very long effect duration and the underlying data is based on a single armed study with limited follow up data collected. And on top of that the typical case also include an expectation that the one-off cost can be absorbed at the time of treatment. An often-proposed idea is to organize risk sharing schemes to help manage economic uncertainty.”

“When it comes to precision medicine, we’d like to look at it as a system transformation where specialized healthcare functions will organize broader diagnostic capabilities as a way of choosing the most appropriate therapeutic intervention for the individual patient. A good example of this shift is childhood cancer in Sweden where all patients now are undergoing whole genome sequencing. This approach will allow medical treatment to be used with precision when it requires a specific genetically based protein expression.

Future Outlook

With evolving policies, economic pressures, and medical advancements, the Nordic pharmaceutical landscape is changing. Despite challenges in affordability, data uncertainties, and system capacity, the region remains focused on high-quality healthcare and innovation.

Looking ahead, what key trends do you foresee in the Nordic pharmaceutical market over the next years?

“The future is always difficult to predict. However, I believe that the Nordic countries with relatively solid economic conditions and ambitions around high quality healthcare will be able to gradually update medical practices as new treatments become available. It might be that we need to enter prioritization measures, and I believe wholeheartedly that this can include the entirety of healthcare spending and not being confined to static medicines budget constraints.”

Written by Lena Mårtensson/Läkemedelsakademin

Learn more

Do you need to learn more about market access in the Nordic countries?

Check out the e-course, “Nordic Market Access,” to get the basics. Discover the key characteristics of each country and gain insights into the essential market access processes and stakeholders.