Belgium’s 2026 health insurance budget foresees €1.5 billion in extra spending and €470 million in savings, nearly half from the pharmaceutical sector. The new savings proposal led to the breakdown of budget talks between the government and Belgium’s pharma sector, and has drawn criticism in parliament, along with a sharp response from Medaxes, representing Belgium’s generics and biosimilars sector.
During the parliamentary Health Commission last week, MP Irina De Knop (Open VLD) challenged Health Minister Frank Vandenbroucke on the failure to reach a pact with industry.
“You say that neither the pharmaceutical sector nor the general practitioners have made any concrete proposals that you could take on board,” she said. “Yet we have detailed notes, both from the pharmaceutical sector and from the doctors’ associations, which set out very clearly how they could achieve a number of savings.”
According to De Knop, these notes showed that savings were possible within medical specialities, that overconsumption could be reduced, and that reimbursement levels for certain procedures could be adjusted.
“It is a well-founded, data-driven proposal, but you simply refuse to look at it,” she told the minister.
Responding, Vandenbroucke confirmed that negotiations with Pharma.be and Medaxes had failed, but said the government had listened to both sides before deciding.
“It is not that we refused to consult,” he told MPs. “When you compare the successive proposals with the final decision of the General Council, you will see that we did take the discussions with the pharmaceutical industry into account. But Pharma.be and Medaxes each submitted alternative proposals that contradicted each other, those of Pharma.be came at the expense of Medaxes members, and vice versa. That made consultation difficult.”
The minister added that he did not rule out renewed talks in the future.
Both associations had submitted plans under an €80 million savings envelope. When no agreement was reached, the government moved ahead with across-the-board price cuts, a decision that triggered the debate.
Two industries, one imbalance
In Belgium, Pharma.be represents innovator companies, around 7 % of medicines by volume but 62 % of reimbursement costs, focusing on R&D and early access.
Medaxes covers generics, biosimilars and off-patent drugs, 93 % of medicines but only 38 % of costs, ensuring affordable supply.
Medaxes argues that an “equilibrated” savings effort cannot mean a 50/50 split.
“Medaxes is of the opinion that our proposals were realistic and targeted, aiming to save money where it can be saved without causing collateral damage to the continuity of supply,” the association told Euractiv.
“Our proposals mainly targeted financial rewards for evergreening strategies and exemptions on price decreases linked to patents, two factors that, in times of budget crisis, cannot be justified as they are not directly linked to any societal or therapeutic benefits.”
By contrast, Medaxes described the Pharma.be plan as “ideological, unrealistic and probably detrimental” to baseline medicines, which constitute more than 90% of Belgium’s medicines.
“Appropriate care cannot be organised by limiting impact based on the number of recognised industry associations,” the group said. “It is organised by investing where the return on investment is clear and positive, and by stopping investments where the ROI is questionable.”
Government defends budget design
Vandenbroucke defended the approach as part of a wider balancing act between growth and control.
“The health-insurance budget for 2026 was approved today by the General Council,” he announced on 20 October.
“The insurance system will receive an additional €1.5 billion next year to meet growing needs, bringing the total budget to €41.3 billion under the 2 % growth norm.”
Yet to stay within that growth envelope, he said, €470.8 million in efficiency measures were required: €150 million from medical acts, €50 million from hospital optimisation, €228 million from the pharmaceutical sector, and €47 million from other professions such as physiotherapy and home nursing.
Focus on appropriate use, innovation
Of the €228 million in expected pharmaceutical savings, €80 million will come from a mandatory price discount, while companies will also contribute €10 million to a new Post-Reimbursement Fund designed to support studies on overtreatment and more tailored care.
“Everyone knows someone who has undergone chemotherapy and seen the impact of certain treatments,” Vandenbroucke said. “Through this fund, we want scientists and clinicians to study overtreatment more deeply, with an eye on patients’ wellbeing. Ultimately, this research should lead to better and more appropriate treatments.”
Other measures include antibiotic dispensing per treatment course, stronger hospital price negotiations, and a minimum €2 co-payment to fund faster access to innovative therapies and extend Maximum Billing to selected drugs.
Two major prescription-behaviour measures, targeting proton-pump inhibitors and cholesterol-lowering drugs, are expected to save more than €80 million combined. Both will be supported by public information campaigns to encourage appropriate use.
“The best saving in the pharmaceutical sector is to prescribe less,” the minister told MPs.
“The wish of the government, and also my personal wish, is not that people should pay much more in co-payments,” Vandenbroucke said.
“Our wish is that fewer acid inhibitors are prescribed. But to create that awareness, one must also send a clear signal.”
He added that the savings would be reinvested to speed up access to innovative medicines.
“With this measure, we will free up resources to grant reimbursement more quickly for absolutely necessary, innovative medicines, which are often expensive,” he said. “We will accelerate the often very long reimbursement procedure for those medicines, often awaited by patients, often by children.”
Medaxes welcomes safety net
Medaxes said it was “not satisfied” with the outcome but welcomed a safety-net exempting medicines already subject to steep price erosion or limited turnover, calling it “a rational policy instrument.”
“This will limit the most severe collateral damage, and we see this as a rational policy instrument,” the group said.
The association also voiced concern for the biosimilars market, warning that without accompanying uptake measures, additional price cuts could make Belgium even less attractive for producers.
“Accompanying measures to give faster market access and create substantial uptake volumes for biosimilars will be needed urgently,” Medaxes added.
Call for renewed dialogue
“We are in constant dialogue with the government, but sometimes we hear each other, but we don’t listen to all arguments,” Medaxes told Euractiv. “It is very important that the government sees the medicines budget as an investment in the health of our citizens and not as a cost that needs to be contained at all cost.”
“Both industry sectors, innovators and baseline medicines, can be valuable partners in creating a clear vision on access and sustainable affordability. Only continued dialogue and an open mind can lead to a common vision on how we can achieve this.”
At the time of publication, Pharma.be had not yet responded to a request for comment.
(BM)
