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Belgian Parliament has adopted urgent 2026 healthcare budget measures: what’s the impact on the pharma industry?

Over the Christmas break, the Belgian Parliament adopted an urgent law with several measures linked to the approved 2026 healthcare budget, with effect from 1 January 2026. The law is intentionally limited to provisions that must enter into force immediately to ensure that the required savings and revenues are available from the start of the budget year. Several measures are directly relevant for pharma companies. This blog post highlights the key takeaways and briefly examines the central budgetary provisions affecting the sector.

Key takeaways for pharma

• The EEFA / Fast Access Programme will apply from 1 January 2026, with a €25 million funding envelope financed via a new minimum patient contribution.
• Hospital invoicing rules change: the invoice rate for certain medicines will drop from 85% to 78% (targeted savings: up to €42 million).
• Reimbursement category shifts (including for acid reducers and cholesterol medicines) are expected to increase patient contributions; further measures (including claw-back changes and price measures) are likely to follow later in 2026.

Fast Access Programme rollout

Back in 2024, Parliament passed two laws that partially reformed the medicines reimbursement procedure. One of the pillars of that reform was the Early and Equitable Fast Access (EEFA) procedure, applying from 1 January 2026.

As far as ‘fast access’ is concerned, companies may obtain compensation for providing a medicine free of charge to eligible patients pending a final reimbursement decision. The law provides for a €25 million funding envelope, separate from the regular medicines budget, funded  through the minimum patient contribution (discussed below). According to the bill’s sponsor, this figure is a forecast based on the medicines projected to reach the market in 2026. The General Council of the National Institute for Health and Disability Insurance (NIHDI) may adjust this amount during the year (and the following years).

If the final reimbursement decision is taken at a price higher or lower than the compensation fee, a balance settlement will apply for 75% of the difference. The urgent law gives effect to this settlement mechanism as well.

Cost-saving measures for pharmaceutical spending

To control pharmaceutical spending, the 2026 healthcare budget introduces several cost-saving measures on medicine reimbursements. The most urgent ones are implemented through the new law and took effect on 1 January 2026:

1. A first cost-saving measure concerns the fixed invoicing of certain reimbursable medicines dispensed in hospital pharmacies. For contrast agents and clustered medicines, hospitals can currently invoice the health insurance system for only 85% of the applicable reimbursement basis. The purpose of this partial invoicing has been stated to align reimbursements with the actual costs incurred by hospitals for medicines after discounts. To generate savings of up to 42 million EUR, the invoice rate will be reduced to 78%.
2. A shift in reimbursement category for certain medicines represents a second cost-saving measure. In particular, acid reducers shift from category B to Cx. Statins, ezetimibe, and certain combinations of these cholesterol-lowering medicines move from category B to C. This will increase patient contributions, aiming to reduce the perceived overconsumption of these medicines.
3. The law further introduces a minimum patient contribution as an additional means of bolstering the healthcare budget. This minimum payment per package of a reimbursable medicine dispensed in a public pharmacy will be set at 1 EUR for modestly resourced patients and 2 EUR for others, regardless of reimbursement category. This measure is intended to fund the EEFA budget.
4. Finally, the standard annual levies are maintained for 2026 (no increases and no new levies). These are the 6.73% standard levy on the turnover of reimbursable medicines, a 1% contribution levy, and a levy on orphan medicines generating more than 1.5 million EUR in revenue. The 0.13% marketing levy, intended to offset the impact of industry promotion on the volume of prescriptions for reimbursable medicines, is also maintained.

Further budgetary measures will follow

Some parliamentarians argued that the pharmaceutical sector was not being asked to contribute enough and questioned whether additional budgetary measures would follow. The bill’s sponsor confirmed that further measures are planned, emphasising that the ones adopted now are limited to the most urgent actions required. Further measures include a stricter claw-back to recover budgetary overspending on medicines through a compensatory levy. Further, as announced in the 2026 healthcare budget, an alternative measure (likely a mandatory price reduction) will be introduced to replace the 80 million EUR anticipatory claw-forward of 2025.

While the new law sets urgent budgetary measures for 2026 in motion, more changes are clearly on the horizon for the pharmaceutical sector and should be monitored closely.

If you would like any further information, please contact Kirian Claeyé (kirian.claeye@altius.com) and Bart Junior Bollen (bart.bollen@altius.com).

Authors: Kirian Claeyé, Bart Junior Bollen