OBJECTIVES: The public focus and interest of decision makers on sustainability within the healthcare system is increasing. Consequently, pharmaceutical companies have started to incorporate sustainability goals in their practices often included under the umbrella term environmental, social, and corporate governance (ESG). This study analyzed how sustainability practices are being implemented within national healthcare procurement policies in Europe.

METHODS: Using the keywords 'sustainability', 'sustainable', and 'environment', publicly available grey literature was screened online, including national Health Technology Assessment agencies websites, ISPOR and the European Medicines Agency online databases, and pharmaceutical company websites, to find information relevant to the research topic.

RESULTS: Denmark, Germany, Iceland, Norway, Sweden, and the United Kingdom have recently included sustainable criteria in their tendering and procurement processes. In 2020, Denmark included for the first time environmental criteria in their national tendering procedure. In 2021, Norway, Iceland, and Denmark started issuing joint Nordic tendering procedures which include 'the environment' as a key criterion and consider environmental management, packaging, transportation, and social responsibility. In 2021, Germany approved a Supply Chain Due Diligence Act which introduces obligations regarding environmental protection for manufacturers along their supply value chain. Sweden uses sustainability criteria for the procurement of medical products, consumables, and electrical and medical devices. In the United Kingdom, NICE’s Medtech innovation briefings (MIBs) now consider the environmental impact of health technology, while procurement of pharmaceuticals, medical equipment, and personal care products have started to include sustainability as an award criterion.

CONCLUSIONS: Sustainability is increasingly being included in European public tendering and procurement processes of healthcare technologies. For pharmaceutical companies with more advanced ESG policies, this represents an opportunity for significant differentiation through sustainable product design and aligned operational and supply chain practices.