Table 4.

Benefits and risks relating to tendering for off-patent pharmaceuticals in countries with expanding healthcare coverage. Summary of the published information retrieved in the literature review

Source	Geography	Benefit	Risk
[38]	Middle- and low-income countries	Originator and generic prices reduced by 42.4 and 35% Reduced quality uncertainty (if quality standards imposed) Even manufacturers of originators displayed a comparably high price flexibility
[37]	Jordan	Joint procurement in Jordan, which resulted in estimated savings of 2.4–8.9% in the first year
[34]	Chile	Reduced corruption and less supplier collusion Greater aggregation of purchases lead to 2.8% lower prices (volume effect) Electronic tendering overall lead to a greater than 8% reduction in prices
[36]	Brazil		The requirement for bioequivalence and/or bioavailability tests increased costs by more than 100% for the basic pharmaceutical services component
[35]	China, Ghana, Indonesia, Mexico	Formularies, bulk procurement, standard treatment guidelines, and separation of prescribing and dispensing are broadly applied Increased transparency through publication of tender agreements and procurement prices	Few strategies targeting quality improvement were identified Lack of performance monitoring strategies was observed in all schemes
[54]	China, Guangdong province	High competition level and more winning experiences induced more aggressive bidding behavior of manufacturers	Bidders in low competition were less sensitive to other potential bidders and the experience of past wins