Pharmaceutical pricing and reimbursement information (PPRI): evolution and impact of a policy network over two decades

ABSTRACT

Background

In 2005, the Pharmaceutical Pricing and Reimbursement Information (PPRI) network of public authorities was established to offer a platform for information exchange among authorities responsible for pharmaceutical pricing and reimbursement. The article reviews the evolution of PPRI over its twenty years of existence and aims to identify its contributions to policymakers and the research community as well as areas for future development.

Methods

Based on a framework of structure, process and outcome indicators, adapted from the Donabedian Model, the article examines developments regarding membership in terms of geographic and thematic scope, governance, procedures for intra-network exchange of information as well as stakeholder engagement, and outcomes in terms of scientific output and spin-off activities. The review was informed by grey and peer-reviewed literature as well as unpublished information within the PPRI network.

Results

The PPRI network has evolved from a European group into a global network, comprising approximately 80 public authorities in pharmaceutical pricing and reimbursement from 50 countries. Its thematic focus remains pricing and reimbursement policies, and additionally, the PPRI network addressed several related topics. In 2018, a sub-group on medical devices (PPRI MD) was established. PPRI mainly serves its members by facilitating informed discussion at face-to-face and online meetings, and through internal queries on timely and policy-related topics. PPRI-sourced data has been published, including country information such as PPRI Pharma Profiles and Briefs, and scientific studies based on cross-country analyses. PPRI conferences offer an opportunity for disseminating scientific output and engaging with stakeholders.

Conclusion

PPRI is a network that has proven its value to policymakers by fostering information exchange as well as by producing reliable and relevant evidence. Success factors identified include a robust governance structure with clear responsibilities, a dedicated Secretariat as a coordinating function and the safe-space character of the network for its members.

Background

Decisions on pharmaceutical pricing and reimbursement for medicines have always been the national competence of European countries, even though the marketing authorisation process for most medicines has been centralised in the European Union (EU) for three decades (Rejon-Parrilla et al., 2023; Ronco et al., 2021).

EU member states vary in terms of market size, income, the relevance of the pharmaceutical industry and governmental priorities in health and industrial policies. Despite these differences, they all have been striving to ensure universal health coverage through solidarity-based health systems that are largely funded through taxes or social insurance contributions. In European countries, medicines are usually provided for free to the patients admitted to a hospital, and substantial shares of the costs for medicines for outpatient use tend to be publicly funded (Leopold et al., 2023).

Since the 1990s, several European countries have reformed their pricing and reimbursement policy frameworks by introducing new policies (e.g. to fund high-priced medicines or address medicine shortages), expanding their scope (e.g. from generics to biosimilars) and adapting new methodological approaches (Sarnola et al., 2018; Vogler, 2024; Vogler, Schneider, et al., 2021; Vogler, Zimmermann, and de Joncheere, 2016; Vogler, Zimmermann, et al., 2011). To support policy implementation, policymakers have been interested in learning from pharmaceutical policies implemented in other countries.

However, opportunities to meet colleagues from other countries and to exchange information were limited in the early years of the new millennium. A few publications narratively described pharmaceutical systems, mostly focusing on large European markets, but they tended to be outdated when policy changes occurred, since at that time no sustainable reporting mechanism had been established to systematically incorporate updates.

Against this background, the Austrian National Public Health Institute submitted a project proposal to the European Commission in 2004, aiming to develop a mechanism for the continuous collection and publication of up-to-date country information on pharmaceutical pricing and reimbursement policies in European countries, through the creation of a network of public authorities. The project entitled ‘Pharmaceutical Pricing and Reimbursement Information (PPRI)' for a duration of two years, funded by the European Commission and co-funded by the Austrian Ministry of Health, started in April 2005 and brought together public institutions, mainly pricing and reimbursement authorities, from 19 European countries. Funding by the European Commission was discontinued in 2007, but the partner institutions, meanwhile having grown to represent 31 countries, urged the Austrian National Public Health Institute as PPRI coordinator to explore solutions for keeping the network sustainable. As a result, the PPRI Secretariat was established at the Austrian National Public Health Institute, and the Austrian Ministry of Health has since then provided funding to the Austrian National Public Health Institute for coordinating the PPRI network.

In 2025, PPRI celebrated its 20th anniversary. During two decades of its existence, the network has grown to 50 countries globally and has spurred regional networks. Pricing and reimbursement policy matters have been discussed together with related, newly upcoming topics, and the pharmaceutical policy debate was broadened by consideration of medical devices (including in vitro diagnostic medical devices). Methodologies, such as reporting systems for generating and comparing country pharmaceutical policy information and glossaries, have been further optimised, and additional deliverables, beyond the scope of the initial PPRI project, were produced (e.g. development and finetuning of the PPRI network query tool for ad-hoc cross-country data collection and systematic intra-network reporting back, collation and publication of policy reform measures (Vogler, Zimmermann, & de Joncheere, 2016; Vogler, Zimmermann, et al., 2011), and organisation of scientific conferences as stakeholder engagement activity). Importantly, while PPRI primarily aims to support public authorities, its outputs offer valuable insights to the research community.

The objective of this article is to review the evolution of the PPRI network over its first twenty years, in terms of its members and further stakeholders, governance and organisational developments as well as methodological, scientific and policy-impacting outputs. We aim to explore the value of PPRI for policymaking and for research, and to identify potential areas for future developments.

Methods

The paper is based on a mixed-methods approach combining a scoping review and surveys with PPRI network members to collate information provided in accordance with a conceptional framework.

Major information sources include publications in peer-reviewed and grey literature, and unpublished documentation in the PPRI repositories, such as the PPRI Intranet. Key search terms included ‘PPRI' and ‘Pharmaceutical Pricing and Reimbursement Information', relating to the PPRI network or further groups under the PPRI umbrella as well as PPRI outputs (e.g. methodology documents, country policy information, studies using PPRI data). Identification of relevant publications and documents was facilitated by the long-standing PPRI coordination of the authors.

Two internal evaluations, conducted in 2017 and 2025, collected feedback from PPRI members on the use of and satisfaction with the PPRI network’s activities, resources and services. Both evaluations were based on online surveys (2017 survey: 22 responses; 2025 survey: 35 responses). The 2025 evaluation was additionally informed by interviews, which were conducted with seven current network members and three former PPRI network members from July to September 2025. While a detailed presentation of the survey findings is outside the scope of this paper, the discussion section particularly incorporates some key high-level learnings related to success and risk factors. In addition, at a symposium held on the occasion of PPRI’s 20th anniversary in September 2025, invited guests discussed with PPRI members the potential value and limitations of PPRI as well as its future.

The review is conducted based on a conceptional framework adapted from an Enhanced Donabedian Model: Originally developed for the assessment of quality in health care, the Donabedian Model was adapted to support additional assessments, such as health services and legal and health policy analysis (Domfeh, 2021; Moullin et al., 2013; Ness, 2024). For the present analysis, meaningful structure, process, and outcome indicators for the assessment of a policy network such as PPRI were developed (see Supplemental Material S1, listing defined indicators and the evidence used to populate these indicators).

Results

Key aspects of the PPRI network are summarised in a narrative review below, supplemented by further details analysed for each indicator in Table 1.

Table 1.

Structure, process and outcome indicators of PPRI, as of Q1/2026.

Indicator	Data for PPRI
Structure indicators
Membership	Number of countries 50 member countries, covering all 27 European Union Member States, 15 further countries from the WHO European region, three countries from the WHO Western Pacific Region, two countries each from the WHO Region of the Americas and Eastern Mediterranean Region and one member from the WHO African Region. See Figure 1 regarding membership developments. Number of institutions 80 institutions (thereof 76 national member institutions, with approximately 33% of them being ministries of health, 30% represent health insurance, 18% are national medicines agencies, 3% research institutions, 4% dedicated national health services and 12% further institutions, e.g. HTA agencies, hospital procurement funds) and four European and international institutions (European Commission, represented by the Directorate-General for Health and Food Safety (DG SANTE) and the Directorate-General for Competition (DG COMP), the Organisation for Economic Co-operation and Development (OECD), and the World Health Organization (WHO), represented by Headquarters and the WHO Regional Office for Europe), and the World Bank.
Governance	Organisational and governance structure PPRI established a governance structure and adapted it over time (Figure 2). It includes a coordinating and managing function (the PPRI Secretariat, affiliated to the Austrian National Public Health Institute), an informal advising function (the PPRI Advisory Board), and experts from PPRI members institutions, which form the main body of the network. Clear rules and responsibilities and existence of guidance documents Rules and principles have been formulated and formalised (e.g. in written guidance documents). The PPRI Secretariat is responsible for communicating this set of good procedural practices to new members (as part of the onboarding process) and for monitoring and, where needed, encouraging compliance (see also process indicators).
Resources	Funding The activities of the PPRI Secretariat to manage the PPRI network, including the sub-group on medical devices from 2018, have been funded by the Austrian Federal Ministry of Health since 2008. From 2005 till 2007, the initial PPRI research project had been commissioned and funded by the European Commission, with co-funding of the Austrian Ministry of Health. PPRI network members self-fund their activities, including travels to PPRI network meetings. No membership fee is charged. Infrastructure / meeting resources PPRI network members have been volunteering to host the on-site PPRI network meetings (held 1–2 times per year) on a rotating basis. Data repository The PPRI Secretariat uses the website ppri.goeg.at as a central tool for storing and communicating information generated within PPRI. The public website offers methodological tools such as the PPRI Glossary and PPRI Indicators (planned launch in Q2/2026) and PPRI-sourced publications (see below outcome indicators). Additionally, PPRI members have access to a dedicated Intranet.
Thematic scope	Thematic focus and expansion in terms of policies Pharmaceutical pricing and reimbursement have remained the core thematic focus of PPRI. Over the years, the PPRI network has addressed several policy-related topics, such as confidential discounts, managed-entry agreements, horizon scanning and health system preparedness, health technology assessment, pharmacy remuneration, early access schemes, patient involvement, pharmacy services, medicine shortages, local production, and cross-country collaboration. Topics discussed in PPRI were always linked to pharmaceutical pricing and reimbursement policy questions (e.g. can higher prices reduce medicine shortages?). Expansion in terms of settings The initial PPRI research project (2005–2007) focused on national policies in the outpatient (i.e. community) sector. Its final report pointed to a lack of knowledge regarding the policy framework of medicines used in hospitals (Vogler et al., 2008). In response, experts from the PPRI Secretariat, as part of an international consortium, conducted the Pharmaceutical Health Information System (PHIS) project. PHIS examined policies for medicines that are used in hospitals and at the interface between hospital and outpatient sectors in European countries. It also surveyed and analysed confidential discounts for medicines procured in 25 hospitals across Europe (Vogler et al., 2010) and expanded the PPRI network by involving hospital managers and hospital pharmacists, leading to the establishment of the PHIS network. Drawing on the tools and methods developed in PPRI, such as the development of a glossary and indicators, PHIS served as a sister project to PPRI. The PHIS project, which was funded by the European Commission and the Austrian Ministry of Health, ran from 2008 to 2011. After its completion, PHIS activities were integrated into PPRI, which, since then, covers the outpatient sector, the inpatient sector, and the interface between the two sectors. Expansion in terms of health technologies PPRI has always covered all types of medicines in their entirety, as well as specific groups of medicines (e.g. high-priced medicines, orphan medicines, generics and biosimilars). Recognising the need to broaden policy discussion beyond medicines, PPRI identified the importance of addressing additional health technologies and, in 2018, established the PPRI sub-group on medical devices (PPRI MD).
Process indicators
Intra-PPRI engagement frequency	Meetings (in quantitative terms) Between 2005 and the end of 2025, a total of 34 PPRI network meetings were held, thereof 29 meetings on-site in 23 different cities, and five online meetings during the COVID-19 pandemic. Since 2018, eight meetings of the sub-group of medical devices were held, either as separate online meetings or as fringe or parallel meetings to the core PPRI network meetings. PPRI network queries (in quantitative terms) Between the PPRI network meetings, structured information-sharing is facilitated through PPRI network queries on topics of interest for public authorities. Since the first PPRI query in 2008, more than 700 queries have been launched. They include questions related to regulation and policy implementation for medicines and medical devices in the PPRI member countries.
Intra-PPRI engagement procedures	Meetings (procedural aspects) Meetings, including those held online, have been designed to maximise active participation and information exchange. Interactive sessions form key elements. PPRI network members are expected to report in a structured manner on policy changes in their country (e.g. through the presentation of country posters, see also outcome indicators below). PPRI network queries (procedural aspects) As part of PPRI’s good procedural practices, guidelines for launching and responding to PPRI network queries were developed and communicated to the members. These guidelines aim to reduce the workload for PPRI network members given an overall high number of queries. Some queries may require research and consultation with colleagues, especially when the topic lies outside the core area of expertise of the person responding. Through these procedural rules, the PPRI Secretariat aims to ensure fairness, e.g. by mandating the person who launched a query to share the summary of results with all.
Stakeholder engagement	PPRI conferences In total, five PPRI Conferences were held to offer external stakeholders a forum to engage with the PPRI community, learn about the policy debates within the network and gain insight into evidence generated by PPRI. All conferences were organised as on-site events in Vienna (29 June 2007, 29–30 September 2011, 12–13 October 2015, 23–24 October 2019 and 25–26 April 2024). While the first PPRI Conference in 2007 served as the concluding event of the initial PPRI research project and presented its findings, the subsequent conferences were designed as scientific conferences, where researchers and further stakeholders were invited to present based on accepted abstracts. The 2015, 2019 and 2024 Conferences were accompanied by the publication of the accepted abstracts, as well as the conclusions of the conferences, in conference proceedings (Vogler, Zimmermann, et al., 2021; Vogler, Zimmermann, Ferrario, et al., 2016; Vogler et al., 2024). PPRI website Since 2018, evidence generated through PPRI and information about activities of relevance for stakeholders have been published on the public website ppri.goeg.at. Information is regularly updated; and the website will be subject to a relaunch in 2026.
Outcome indicators
Development of methodologies	Glossaries The first glossary was launched in 2006. Since then, it has been subject to updates, extensions, improvement of definitions, and production of glossaries in other languages. The latest version of a comprehensive PPRI Glossary was published in 2025 (Knoll & Vogler, 2025). Reporting templates Reporting templates were established for different versions (posters, PPRI Pharma or Medical Devices Brief, PPRI Pharma Profiles). PPRI Indicators PPRI Indicators comprise key pharmaceutical systems characteristics and policies in more than 20 categories, filled with information from PPRI member countries. 65 PPRI indicators were integrated into a dashboard that will be made publicly accessible. For details and examples of glossaries, templates and background information on the PPRI Indicators see Supplemental Material S2.
Country information	PPRI Profiles and Briefs PPRI Profiles and Briefs are available for 28 countries (Albania, Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Malta, Netherlands, Norway, Poland, Portugal, Republic of Korea, Slovakia, Spain, Sweden, Türkiye, United Kingdom). PPRI Posters PPRI Posters are available for 47 countries which are current PPRI member countries. For examples of PPRI Profiles, Briefs and Posters see Supplemental Material S2.
PPRI-sourced publications	Peer-reviewed articles More than 20 articles were published, using information generated by PPRI, and/or provided by PPRI network members. Further publications More than 10 technical reports and around 20 book chapters were informed by PPRI information. For an overview of publications see Supplemental Material S2.
Visibility and representation in the policy field	Representation in policy groups PPRI has been an observer member of the National Competent Authorities on Pricing and Reimbursement and Public Healthcare Payers (NCAPR) group. Awards PPRI was shortlisted for the European Health Forum Gastein (EHFG) Award 2009. PPRI was selected as the Austrian Public Health Project with an important impact for EU Member States 2011. The 2019 Helen Clark-JoPPP Award was awarded to one of the PPRI founders.
PPRI spin-offs	PPRI EECA (Eastern Europe and Central Asia) In 2017, at the request of the WHO Regional Office for Europe, experts of the PPRI Secretariat established the PPRI EECA (Eastern Europe and Central Asia) network to involve countries of that region (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan). As in the core PPRI network, members are public authorities responsible for pharmaceutical pricing and reimbursement; membership in both PPRI EECA and the core PPRI network is possible. A key difference concerns the working language which is Russian in PPRI EECA (in contrast to English in core PPRI), while PPRI’s working principles have been applied and yielded similar outputs (e.g. a glossary in Russian language, a comparative study on pharmaceutical pricing and reimbursement policies across the PPRI EECA countries, available in English and Russian languages (Vogler et al. 2020). From 2017 till 2022, the WHO Regional Office for Europe funded the activities of the PPRI EECA Secretariat as well as travels of member institutions. PPRI Africa Since no dedicated network of public authorities for pharmaceutical pricing and reimbursement existed in Africa, PPRI Africa was established as an initial one-year pilot project to explore interest and feasibility for such a network. The PPRI Africa network was set up and is coordinated by experts affiliated to the PPRI Secretariat, with financial support from TESS Mav + through the Belgian agency for international cooperation ENABEL. As of Q1/2026, 14 countries (Algeria, Egypt, Côte d‘Ivoire, the Gambia, Guinea, Kenya, Mauritius, Morocco, Namibia, Niger, Rwanda, Senegal, South Africa, Tunisia) and two international institutions (AfricaCDC and WHO Afro) were members, and both English and French were used as working languages. Since its establishment until Q1/2026, PPRI Africa held two on-site network meetings and four online training sessions, produced outcomes, e.g. a price comparison report and a policy overview, and could confirm interest of its members. At the time of the submission of this paper, PPRI Africa was prolonged for six months and is working on ensuring its long-term sustainability.

Membership and governance

PPRI started as a project bringing together public authorities responsible for pricing and reimbursement of medicines in 19 European countries. While in the early stages the PPRI Secretariat approached eligible institutions and invited them to join the network, growth from 2010 onwards was attributable to the interest of potential members. Over the years, an increasing number of public authorities from outside Europe requested PPRI membership, and this resulted in PPRI becoming global. Figure 1 presents major phases of PPRI’s extension.

Figure 1.

PPRI membership growth. WHO: World Health Organization. Note. The decrease in the number of PPRI member countries is attributable to the suspension of Belarus and the Russian Federation in 2022 after Russia’s attack on Ukraine.

From the onset, PPRI has been defined as a network for and with public authorities working on pharmaceutical pricing and reimbursement policies. Its members include technical experts from ministries of health, social insurance institutions, national health services, and public procurement agencies. PPRI network members do not receive any compensation for their contributions. In return, PPRI does not charge a membership fee.

European and international institutions may also participate upon invitation, and, in Q1/2026, the European Commission, the Organisation for Economic Co-operation and Development (OECD), the World Health Organization (WHO) and the World Bank were members.

The PPRI Secretariat is hosted by the Austrian National Public Health Institute. The PPRI Secretariat is responsible for the overall management of the PPRI network, and these coordination activities are funded by the Austrian Federal Ministry of Health. PPRI-related activities include membership and stakeholder management, thematic leadership and representation and dissemination activities. The Secretariat developed rules and principles to define members’ responsibilities in the network, to foster active participation of all members, to encourage open discussion in an atmosphere of trust and to ensure that published data are effectively quality-assured.

In 2017, an Advisory Board was established as an informal entity to provide strategic guidance to the PPRI Secretariat. Representatives of the Austrian Ministry of Health, as well as of European and international organisations and selected experts from national PPRI member organisations serve on the PPRI Advisory Board on rotating terms (for a visualisation of PPRI’s governance structure see Figure 2).

Figure 2.

PPRI governance structure.

Regional and thematic expansion

In addition to growing global PPRI membership, the establishment of regional networks inspired by the PPRI model was piloted, resulting in PPRI Eastern Europe and Central Asia (PPRI EECA), established in 2017, and PPRI Africa, implemented as a pilot project in 2025. Upon permission of the PPRI Secretariat, these regional networks may use the name ‘PPRI' and PPRI tools (such as reporting templates), which were adapted to the needs of their members. However, their governance and funding structures differ from those of the core PPRI network (for further details see Table 1, outcome indicators).

The initial two-year PPRI project identified a substantial knowledge gap in the hospital sector. This led to the launch of PPRI’s sister project ‘Pharmaceutical Health Information System' (PHIS), which analysed policies for medicines used in hospitals and at the interface of outpatient and hospital sectors (Vogler et al., 2010; Vogler, Zimmermann, Habl, et al., 2013; Vogler, Zimmermann, Leopold, et al., 2013; Vogler et al., 2014). After the end of the PHIS project in 2011, its activities were taken over by PPRI.

This integrative and comprehensive approach has continued to shape PPRI’s activities. While pharmaceutical pricing and reimbursement remained a thematic focus, related topics, including horizon scanning, health technology assessment, pricing and remuneration in the supply chain, innovation, measures to foster the uptake of off-patent medicines and patient and public involvement, have also been examined.

Acknowledging the need to expand beyond medicines, and in response to the expression of interest from members, a PPRI sub-group on medical devices (PPRI MD) was established in 2018, operating under the same principles and values as the core PPRI network.

PPRI’s toolbox

A methodology toolbox offers instruments, such as glossaries, reporting templates, and indicators, to define, measure, survey, and comparatively analyse country information on policies for medicines and further health technologies.

The PPRI Glossary was developed to support common understanding and clear terminology. Following its first publication in 2006, the glossary has been updated, extended (i.e. to include new terms, e.g. relating to medical devices), refined (i.e. change in definitions) and translated into different languages (Knoll & Vogler, 2025). Serving a similar purpose, reporting templates support authors in presenting country policy information in a homogeneous manner, thus facilitating cross-country comparison. The PPRI Secretariat produced multiple formats to account for different levels of detail, ranging from templates for one-page country posters to PPRI Pharma Briefs and PPRI Pharma Profiles. These templates are accessible on PPRI’s public website and can be used by any researcher. The PPRI Secretariat also developed the PPRI Indicators, which measure the implementation of relevant policies in pharmaceutical pricing and reimbursement, and filled these indicators with information from its 50 member countries. The PPRI Indicators on pharmaceutical policies have been used for scientific articles, including technical reports (Vogler et al., 2008; Vogler & Fischer, 2020; Vogler et al., 2019), book chapters (Vogler, 2019, 2020, 2025; Vogler & Martikainen, 2015) and articles (Leopold, Mantel-Teeuwisse, et al., 2014; Leopold et al., 2023; Leopold et al., 2012; Leopold, Zhang, et al., 2014; Vogler, Habl, et al., 2011; Vogler & Martikainen, 2015; Vogler, Schneider, et al., 2021) and were integrated into a dashboard.

Information-sharing among members and dissemination of scientific outputs

The primary purpose of PPRI is to offer a platform to technical experts working on pharmaceutical policy implementation in public authorities, which allows them to learn from each other and to share information.

Internal evaluations highlighted that PPRI network members particularly appreciate network meetings and PPRI network queries as tools for information-sharing. PPRI network queries are brief ad-hoc requests for data on specific aspects of the policy landscape and solutions in other PPRI countries. Clear procedures, overseen by the PPRI Secretariat, aim to ensure high participation in these queries and reporting back of summarised findings to the network.

In addition to fostering informal exchanges, PPRI aims to collate information and share quality-assured content with stakeholders. Thus, some information generated through PPRI is disseminated on the PPRI website and through further channels, including scientific reports and articles. PPRI publications encompass policy information in the PPRI countries (e.g. through PPRI Pharma Profiles) and comparative country analysis, to provide cross-country overviews of policies (Vogler et al., 2008, 2015, 2019, 2020) as well as comparisons for specific policies across countries, e.g. policies to address medicine shortages (Vogler, 2024; Vogler & Fischer, 2020), generic and biosimilar policies (Vogler, 2012; Vogler, Schneider, et al., 2021), policies for orphan medicines (Rejon-Parrilla et al., 2023; Sarnola et al., 2018).

PPRI network members contributed substantially to successful research projects, which required input from public authorities across the EU, e.g. on the methodological parameters of external price referencing (Vogler, Lepuschütz, Schneider, et al., 2016), practices of public procurement of medicines (Vogler et al., 2022) and biosimilar policies and practices (Vogler et al., 2025).

In addition, dissemination and stakeholder engagement are fostered through the multi-stakeholder PPRI Conferences. Held every four to five years, PPRI Conferences bring together researchers, regulators, policymakers, health care professionals, patients, and industry representatives and allow stakeholders to meet with the PPRI community of public authorities. At these conferences, participants are offered the opportunity to present their research, as well as to learn about the thematic discourse within PPRI (Vogler, Zimmermann, et al., 2021; Vogler, Zimmermann, Ferrario, et al., 2016; Vogler et al., 2024).

Discussion

The PPRI network has undergone several developments, including expansion and diversification in terms of membership, topics, regional focus and methods. These changes were driven by requests from members (and candidate countries) and the perceived need for adaptation identified by the PPRI Secretariat and its members. Given the developments and adaptations throughout the years, the following discussion reflects on the factors of PPRI’s continued success, its limitations as well as the lessons learned for a network of public authorities. We define success relative to PPRI’s aims, namely the provision of a space for trusted exchange amongst technical experts working in public authorities, supporting evidence-based policy through timely publications and building methodological tools for the comparison of policies.

Success factors

The continued and sustained high interest from members in the activities and meetings of the PPRI network indicates that the network has been successful in adapting to current policy developments and in incorporating relevant topics in network meetings and conferences. The sustainability of the network has been facilitated by its governance structure, which is reflected in the efforts of the PPRI Secretariat to capture and respond to the network’s evolution in terms of topics and regional representation. The Secretariat’s continued funding by the Austrian Federal Ministry of Health, as well as its affiliation with the Austrian National Public Health Institute, has proven important pillars of stability for the PPRI network. From the beginning, the PPRI Secretariat has always been affiliated with the Austrian National Public Health Institute, and staff changes have been managed through effective knowledge transfer to incoming team members, who brought in new perspectives. Ensuring sustainability, coupled with the ambition and commitment of the Secretariat team to serve the network members, has proved an indispensable asset during PPRI’s overall evolution.

A robust governance structure, with a strong coordination function, was identified in the literature as an essential prerequisite for the effective functioning of any initiative (Begum & Momen, 2022). From the authors’ perspective, PPRI has been meeting this condition by having assigned the coordinator’s role to the PPRI Secretariat, which developed a set of procedural rules and continues to allocate time resources in communication to members as well as in monitoring the compliance of PPRI practices with the rules, principles, and values. One of the lessons learned in this regard is the importance of ensuring that all network members contribute an equally fair amount to the network activities to ensure a mutually beneficial win-win situation. However, rules around such activities and contributions take time to develop, especially because they can only be successful if members trust the processes and their colleagues within the network. Building, facilitating and maintaining trust are key factors in ensuring members’ acceptance of, and adherence to, the rules and guidelines through which the network is sustained.

Another indispensable requirement for the success of PPRI is its character as a closed network, which allows members to exchange openly in an atmosphere of trust, with a view to optimising policy implementation. The PPRI Secretariat is responsible for protecting a safe environment for its members to foster trust building, which is considered an antecedent and cornerstone of collaboration (Wang & Ran, 2023).

While guaranteeing a protected safe-space for internal discussion among network members, the PPRI Secretariat is also committed to disseminating PPRI methods and scientific outputs. PPRI has contributed to extending the evidence base and to facilitating research by developing methodological tools, such as definitions in glossaries, reporting templates and indicators for cross-country comparison of policies, which can be applied by researchers. In addition, published PPRI country information can be used by stakeholders outside the PPRI network who aim to conduct further studies, e.g. impact assessments. Lastly, PPRI experts produced scientific publications; some of which addressed topics that had been under-researched (e.g. pharmaceutical policies at the interface of outpatient and inpatient sectors, published by Vogler et al. (2023)). PPRI publications benefitted from the breadth and diversity of countries included in the PPRI network and thus addressed one of the biases in the scientific literature that tends to be focused on high-income, large markets.

Despite these scientific publications, people in and outside the PPRI network noted that improved visibility, more publications (not necessarily solely scientific ones) and rapid policy-relevant reactions would be appreciated. The PPRI Secretariat is considering how to accommodate some suggestions of this wish list against the backdrop of limited overall resources.

Risk factors

Despite the successes of the PPRI network, the network has not been immune to risks, especially due to increased membership and expanded scope over the years. Over the past two decades, PPRI has grown substantially in membership, thematic breadth, and visibility; however, the resources available to the network have not increased at the same pace. Meeting growing expectations and ensuring that the network’s activities remain timely and relevant to ongoing developments in pharmaceutical policy require careful prioritisation and resource planning. A further challenge of the outlined expansion relates to knowledge-transfer. PPRI’s work is highly specialised and relies on tacit knowledge accumulated over many years, and built on trust between members. Staff turnover in the PPRI member organisations makes it essential to communicate the rules and guidelines to the network at regular intervals.

Additionally, PPRI’s increasing external visibility carries a risk of misunderstanding the network’s purpose. While transparency is a core value of the network, openness can lead some external stakeholders, particularly in academia and consultancy, to misinterpret PPRI as an open research network rather than a closed policy network for public authorities. Misaligned expectations may create pressures for broader access or more rapid public-facing outputs. Thus, clear communication about PPRI’s distinct goals is crucial to maintain trust, safeguard the safe-space character of the network, and ensure productive collaborations with the research community and other stakeholders.

Limitations

This paper offers an insider perspective that allows linking different topics and activities. While the article provides insights that would be very difficult to access through other methods, it is acknowledged that all authors are members of the PPRI Secretariat. As another limitation, observations of non-recorded discussions, such as at the ceremonial Symposium in 2025, informed the findings on the strengths and limitations of PPRI. Thus, the selected method allows only for a preliminary assessment. A more in-depth impact analysis of PPRI would require additional evaluations, which are beyond the scope of this paper.

Conclusion

Within twenty years of existence, PPRI has evolved from a pilot in response to the perceived need for a forum to exchange policy information on pharmaceutical pricing and reimbursement into a sustainable network for and with public authorities.

Its quantitative expansion, the diversification of its thematic scope, as well as spin-off activities, indicate an added value of PPRI that the network seems to offer to its members.

PPRI aims to support informed and evidence-based policymaking, and this is facilitated by offering a safe space for staff of public authorities to discuss their policy implementation experience, including challenges. Additionally, scientific evidence was generated, which was informed by the PPRI members and which informs decision- and policymaking.

While conducting research is not the primary purpose of PPRI, its evidence generation yields positive external spill-over effects on the research community, given its relevant contributions to the scientific evidence base. Particularly, coverage of smaller countries and countries of lower income through PPRI-sourced data is essential, since these countries tend to be less in the focus of research projects. Furthermore, collation of narrative country information, including a systematic collection of information on policy changes, offers an important basis for further research, which may be conducted within PPRI or externally.

Despite progress in ensuring affordable and sustainable access to medicines in several countries, challenges to pharmaceutical policy persist. Therefore, it is key that the PPRI network continues its work in its best possible manner, drawing on the lessons learned during the last twenty years.

Disclosure statement

No potential conflict of interest was reported by the authors.

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20523211.2026.2670697.