在公共资金少且采购过程分散的医疗系统中，抗癌药物的定价和质量直接影响到患者有效抗癌治疗的获取。差异定价、与采购量有关的协商，以及依赖低价仿制药而不对其质量进行评估等因素可能导致供需滞后、患者高额自费支出和治疗结果不佳。虽然集中采购药品可以解决部分问题，但监督采购过程需要大量行政投资。通过集体协商定价、发放统一的合同，并由各个医院进行采购，也可以降低成本、提高质量，而无需进行大量投资。印度的国家癌症网是一个由250多个肿瘤中心组成的网络，它试点采用集体采购来改善高价值肿瘤治疗和辅助护理药物的可协商性。这个试点中包括了40种药物。根据最高零售价，23个中心对这些药物的需求相当于156亿印度卢比（1.97亿美元）。该过程包括技术和财务评估，然后由各个中心与选定的供应商签订合同。与最高零售价相比，节省了132亿印度卢比（1.667亿美元）。节省幅度从23%到99%不等（中位数为82%），在仿制药中较创新药和新涂药物的节省更多。这项研究揭示了集体协商在集中采购高价值药物方面的优势，这种方法可以应用于其他医疗系统中。（c）2023 作者；世界卫生组织所有。

In health systems with little public funding and decentralized procurement processes, the pricing and quality of anti-cancer medicines directly affects access to effective anti-cancer therapy. Factors such as differential pricing, volume-dependent negotiation and reliance on low-priced generics without any evaluation of their quality can lead to supply and demand lags, high out-of-pocket expenditures for patients and poor treatment outcomes. While pooled procurement of medicines can help address some of these challenges, monitoring of the procurement process requires considerable administrative investment. Group negotiation to fix prices, issuing of uniform contracts with standardized terms and conditions, and procurement by individual hospitals also reduce costs and improve quality without significant investment. The National Cancer Grid, a network of more than 250 cancer centres in India, piloted pooled procurement to improve negotiability of high-value oncology and supportive care medicines. A total of 40 drugs were included in this pilot. The pooled demand for the drugs from 23 centres was equivalent to 15.6 billion Indian rupees (197 million United States dollars (US$)) based on maximum retail prices. The process included technical and financial evaluation followed by contracts between individual centres and the selected vendors. Savings of 13.2 billion Indian Rupees (US$ 166.7million) were made compared to the maximum retail prices. The savings ranged from 23% to 99% (median: 82%) and were more with generics than innovator and newly patented medicines. This study reveals the advantages of group negotiation in pooled procurement for high-value medicines, an approach that can be applied to other health systems.(c) 2023 The authors; licensee World Health Organization.