Medicines on the Single Market Line: Europe Faces a One-Bloc or Country-by-Country Choice
The European Parliament has placed the question of joint EU medicines procurement at the centre of its May plenary in Strasbourg, with liberal and democrat MEPs framing the debate in stark terms: will Europe negotiate medicines as one bloc, or absorb the pressure country by country? Behind the procedural language lies one of the most consequential industrial-policy questions facing the Union — whether the single market’s 450 million consumers can be translated into coordinated negotiating power on essential medicines, or whether national procurement will continue to fragment that leverage.
A market that has shifted under Europe’s feet
The political urgency reflects a reality that has changed dramatically over the past two years. What happens in Washington and Beijing increasingly shows up in European pharmacies and hospitals — through pricing pressure, supply disruptions, and shifts in the global production footprint of active pharmaceutical ingredients. The Iran conflict and the temporary disruption of Strait of Hormuz shipping lanes have added a further layer of supply-chain volatility that European health systems were not designed to absorb.
The political stakes
The Renew Europe group, which has driven the debate, frames the choice in unmistakable terms: Europe must negotiate medicines as one bloc or risk paying the price in higher costs, delayed access, and lost ground to the US and China. The argument is not new — joint procurement was deployed during the Covid-19 pandemic to acquire vaccines — but the political appetite to extend it to a broader range of medicines has historically been blocked by member states protective of their national pricing and reimbursement systems.
The structural problem
Medicines pricing in the EU has long been a paradox: the single market guarantees the free circulation of pharmaceutical products, but pricing and reimbursement decisions remain firmly national. This creates an environment in which manufacturers can negotiate with 27 different payers, each with limited individual leverage, and in which parallel trade arrangements add further complexity. National rebate negotiations, often confidential, blur cross-border price comparisons and make joint action structurally difficult.
What “negotiating as one bloc” would mean
Several models have been put on the table. The most ambitious would establish a permanent EU-level joint procurement mechanism for essential medicines, drawing on the HERA — the Health Emergency Preparedness and Response Authority — and possibly extending its remit beyond strict emergency scenarios. A more modest version would create a voluntary “joint procurement plus” framework for new and innovative medicines, allowing member states to opt in while retaining ultimate control over reimbursement decisions. Critics argue that anything short of mandatory participation would be undermined by free-rider behaviour.
A thriving European health industry — or a hollowed-out one?
The other side of the debate concerns industrial policy. Europe has lost ground over the past decade in pharmaceutical R&D and manufacturing relative to the United States and Asia. Several recent reports have warned that EU regulatory complexity, combined with pricing pressures from national payers, is pushing innovation investment outside the Union. The challenge for policymakers is to combine assertive negotiating power with conditions that keep European companies investing, producing and innovating on European soil.
The Liberals’ bottom line
Renew Europe’s position, articulated by Stine Bosse and other speakers, can be summarised in three demands: accessible medicines, negotiated on democratic terms; European companies with genuine opportunities to innovate; and a Europe that negotiates as one when the moment requires it. That trinity is easier to state than to operationalise — and the Commission, the Council and the relevant pharmaceutical industry associations have all signalled that any move towards mandatory joint procurement would face significant resistance.
What to watch for
The Strasbourg debate is unlikely to produce immediate legislative outcomes. But it sets the political frame for the Commission’s forthcoming Critical Medicines Act and for the reform of EU pharmaceutical legislation more broadly. With the geopolitical backdrop unlikely to improve, the question of one-bloc negotiation will return — and the answer member states give will shape both the cost of medicines in European pharmacies and the future of European pharmaceutical sovereignty.
