The list of drugs that are reimbursed 50%-100% by the mandatory insurance fund is approved

2026-05-06 20:36:00, Politikë CNA

The list of drugs that are reimbursed 50%-100% by the mandatory insurance fund

The government today approved the list of medicines that are reimbursed by the mandatory health care insurance fund and the extent of their price coverage.

Based on the Council of Ministers' Decision, the Mandatory Health Insurance Fund is the institution tasked with determining the medicines to be included in the list.

Also, by Decision of the Council of Ministers, the prices applied for the compilation of lists I and II of reimbursable medicines are based on the revalued prices, approved for 2026.

DECISION

In accordance with Article 100 of the Constitution, point 3, Article 37, of Law No. 105/2014, “On Medicines and Pharmaceutical Services”, as amended, and points 2, letter “b”, and 6, of Article 10, of Law No. 10383, dated 24.2.2011, “On Compulsory Health Care Insurance in the Republic of Albania”, as amended, upon the proposal of the Minister of Health and Social Welfare, the Council of Ministers decided:

1. Approval of List I of reimbursable medicines, marketed in hospital pharmacies, according to Annex No. 1, attached to this decision.

2. Approval of List II of medicines, reimbursed by the Mandatory Health Insurance Fund, according to Annex No. 2, attached to this decision.

3. Approval of the price coverage measure for reimbursable drugs, listed according to the ATC classification, at the rate of 50% - 100%, according to therapeutic groups and drugs, as defined in statement no. 1, attached to this decision.

4. Approval of trading margins for medicines on the reimbursable list, respectively, at the rate of 8% for wholesale and 24% for retail.

5. Approval of differentiated wholesale and retail margins for certain drugs in lists I and II, according to statement no. 2, attached to this decision.

6. The Mandatory Health Insurance Fund is charged with, in accordance with the legislation in force, determining restrictions on the use, quantity and duration of treatment with the drugs on this list, based on economic, medical and social criteria.

7. The Mandatory Health Insurance Fund is charged with, in accordance with the legislation in force, concluding agreements for the reduction of the prices included in this list with the marketing authorization holders.

8. If, during the period when this decision is in force, the prices of unregistered medicines on the list or medicines, the only alternative, that are marketed in hospital pharmacies and in open network pharmacies, are reduced, the Compulsory Health Insurance Fund, upon notification of the National Agency for Medicines and Medical Devices, shall reflect the reduction in the price of the medicine on the list. The medicine control stamp shall be issued after the approval of the price by the Compulsory Health Insurance Fund.

9. The prices applied for the compilation of lists I and II of reimbursable medicines are based on the revalued prices, approved for the year 2026, according to the provisions of decision no. 645, dated 1.10.2014, of the Council of Ministers, "On the establishment and functioning of the Medicines Price Commission", as amended.

10. The Mandatory Health Insurance Fund is charged with updating, within January of each year, the list of reimbursed medicines with prices and commercial alternatives for existing active principles, based on the general list with CIF/EXW prices, approved by December 31 by the Ministry of Health and Social Welfare.

11. The financial effects are covered by the approved budget for the Mandatory Health Insurance Fund for 2026.

12. Decision No. 491, dated 24.7.2024, of the Council of Ministers, “On the approval of the list of medicines reimbursed by the Mandatory Health Insurance Fund and the extent of their price coverage”, as amended, is repealed.

13. The Ministry of Health and Social Welfare, the Mandatory Health Care Insurance Fund and the National Agency for Medicines and Medical Devices are responsible for the implementation of this decision.

This decision enters into force upon publication in the "Official Gazette". /CNA