Greece has introduced significant changes to its clawback mechanism for hospital pharmaceutical spending, a move set to benefit companies producing low-cost drugs.
The updated policy, covering 2023 expenditures, places caps on the amounts pharmaceutical firms must return to the state and completely exempts medicines priced at €5 or less from any charge. Officials say the reform is designed to distribute financial burdens more fairly and strengthen the long-term viability of the sector.
The decision, jointly signed by the ministers of National Economy and Finance and of Health, details a new calculation method for determining budget overruns and the related clawback payments. Hospital pharmaceutical expenditure will be assessed based on invoiced hospital prices for all medicines, after deducting the standard five percent rebate or lower rates secured through central tenders by the National Central Health Procurement Authority (EKAPY), and including VAT. Spending on products covered by closed budgets or central contracts will be excluded from the calculation, allowing authorities to measure the actual overspend against the available budget.
For the first time, the government is introducing maximum clawback rates tied to a drug’s market price. Medicines worth up to €5 will be exempt from repayment, while those priced between €5.01 and €15 will face a maximum 40 percent charge, and those between €15.01 and €30 will face a maximum of 60 percent. If overall budget overruns exceed these limits, the excess will be redistributed proportionally among other categories, following a set methodology.
The reform also allows clawback obligations to be offset against debts owed by hospitals or EKAPY to pharmaceutical companies. In cases where hospitals lack the necessary debit invoices, EKAPY will carry out the offsetting process itself. Such offsets may apply to debts from the same fiscal year, the previous year, or the year ahead.
Clawback amounts will be calculated quarterly or semi-annually and recorded as revenue in the budgets of public hospitals, the Papageorgiou General Hospital in Thessaloniki, and EKAPY. Pharmaceutical companies or marketing authorization holders that fail to comply with repayment obligations risk suspension of their supply agreements until debts are cleared.
