3 July 2026
New European research shows that confidential pricing agreements between governments and pharmaceutical companies have surged across Europe, but reporting remains so inconsistent that countries cannot tell whether they’re getting a fair deal compared to their neighbours.
In March, a study from the European Fair Pricing Network (EFPN) revealed that European hospitals pay wildly different prices for the same cancer medicines, sometimes more than double, even between hospitals in the same country. A new EFPN study now shows that this is not just a hospital-level problem. It runs all the way to the top; through the confidential agreements national governments themselves strike with pharmaceutical companies.
These agreements, known as Managed Entry Agreements (MEAs), let governments negotiate a discount on a medicine’s official price, in exchange for keeping the size of that discount secret. The new study, A Comparative Analysis of Managed Entry Agreements in Europe, examined these agreements across 13 European countries between 2016 and 2022. It finds that their use has exploded and that the secrecy built into the system means governments are negotiating blindly, with no way of knowing whether their neighbours are getting a better deal.
Billions in secret deals, and growing fast
The study found that reported discounts ranged from 14% in Germany to 54% in Belgium and that reported savings can range from €40 million in Slovakia to €5.56 billion in France. These figures point to the scale of public money involved, however the researchers do warn these findings cannot be meaningfully compared, because countries report these in different and therefore incomparable ways.
What is clear, however, is the rapid growth of these agreements: across seven European countries, the number of active agreements rose by an average of 65% between 2018 and 2022, with the steepest growth in Belgium (+250%) and Norway (+227%). By 2022, France and Germany each had over 300 of these types of agreements in place.
Two pieces of the same puzzle
Prof. Wim van Harten, principal investigator of EFPN: “Even with full access to public reports and interviews with national experts, we could not get a complete picture for most countries. If it takes researchers years of work to get this far, governments themselves are negotiating with even less information on their relative performance than we had.”
Together, the two EFPN studies show that the real price of a medicine, what a hospital pays, and what a government pays on behalf of its hospitals, gets hidden behind layers of confidentiality at every level of the system. Patients, taxpayers and even the public bodies negotiating on their behalf are left in the dark about whether public money is being spent well.
A fix that doesn’t require breaking confidentiality
Crucially, the researchers stress that closing this information gap does not mean abandoning confidential negotiations. Some countries already show what’s possible: The Netherlands separates public and confidential discounts in its reporting, France publishes financial breakdowns by disease area, and Sweden reports on forecasted versus actual spending: all without revealing what any single company negotiated.
The study proposes a standard set of aggregated figures, such as average discounts, number of agreements per medicine category, and spending trends, that every EU country could report in the same way, in English and in local languages. This would let governments, for the first time, see how their own negotiations compare, without any single contract being made public.
“This study makes it clear that the EU should revise the outdated Transparency Directive to shine a light on confidential medicine deals without exposing individual prices. Countries should at least report, in the same way, how many deals they make, what they cover, how much public money is involved, and whether they deliver. Without that, governments negotiate in the dark and patients and taxpayers are left guessing.” says Toma Mikalauskaitė, Head of Policy at the Association of European Cancer Leagues.
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About EFPN
The European Fair Pricing Network (EFPN) brings together national cancer societies, research institutes and European cancer organisations to promote fair pricing and better access to innovative cancer medicines. EFPN members include the Association of European Cancer Leagues (ECL), the Dutch Cancer Society, the Netherlands Cancer Institute, the Organisation of European Cancer Institutes, the Swiss Cancer League, Stand Up To Cancer Flanders, the Norwegian Cancer Society, the Cyprus Association of Cancer Patients and Friends, and the Nordic Cancer Union.
