| Summary: | 1. There is a growing interest in further developing cross-border collaboration in the field of health, both at a bilateral and a multilateral level. This is supported by European Union (EU) legislation and policies, and extends to improving access to health technologies.2. Changes in health technologies markets, such as the generalization of managed entry agreements (MEAs) and the prevailing lack of price transparency - particularly in price discounts - require different approaches to those applied in the past.3. There is a sound rationale for increased voluntary collaboration between countries in the procurement of health technologies: to enhance transparency through better information sharing to enable cross-country learning by sharing experience to strengthen bargaining power and mitigate overly high transaction costs by pooling skills, capacities and through joint negotiations to ensure sustainable access to health technologies by sharing resources through cross-border exchange of products in short supply.4. However, in practice, developing sustainable cross-border collaboration in procurement seems to be challenging. Experiences in Europe are still limited and too recent to really allow clear lessons to be drawn about their effectiveness and impact.5. Nevertheless, it is clear that related initiatives would require strong political commitment and mutual trust between purchasing partners in order to succeed. It is therefore advisable that they be built progressively, starting with collaboration in information sharing and knowledge exchange, before moving towards joint purchasing activities
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