Belgium has made an €80.4 million annual pharmaceutical-sector contribution a permanent part of medicines financing from 2026. The Law containing various health provisions (Loi portant des dispositions diverses en matière de santé), published on 11 August, also changes reimbursement procedures and establishes a specific framework for combination treatments.
The new payment should be seen alongside Belgium's existing industry contributions. Companies already pay a standard levy of 6.73% on reimbursed-medicine turnover and a further 1% contributive levy. Higher-turnover orphan medicines attract an additional graduated contribution, while a separate marketing contribution is intended to offset the effect of promotion on prescribing. Parliament estimated that these established turnover-based charges would raise around €600 million in 2026. They apply irrespective of whether pharmaceutical expenditure exceeds its budget.
The €80.4 million has a different origin. Belgium introduced the same amount as a temporary ‘clawforward’ in its 2025 budget. This secured the saving in advance while the sector was required to propose measures producing an equivalent structural reduction in expenditure from 2026. The 2026 budget retained the €80.4 million target and provided for a general medicine price reduction if an alternative was not implemented.
The new law instead converts the amount into a recurring annual payment. Each company's share is based principally on its proportion of reimbursed turnover, with exclusions for some established low-turnover medicines and a 50% weighting for turnover from medicines covered by managed-entry agreements. The first payment is due before 1 November 2026.
This sits alongside the separate clawback. Under Belgium's multiannual medicines framework, pharmaceutical spending is limited to 17.3% of authorised net health-insurance expenditure. Industry must compensate any overshoot of that budget, with the government previously estimating potential 2026 clawback exposure at up to €270 million. Unlike the fixed turnover contributions and the new €80.4 million payment, the clawback therefore arises only if expenditure exceeds the agreed ceiling.
The law also allows the Healthcare Service of the National Institute for Health and Disability Insurance (Institut national d'assurance maladie-invalidité / Rijksinstituut voor ziekte- en invaliditeitsverzekering, INAMI/RIZIV) to make final reimbursement-list decisions itself for specified generics, biosimilars, hybrids and lower-budget applications.
It also creates a legal basis for coordinating reimbursement procedures for combination treatments supplied by different companies. Detailed rules can align applications, decisions and implementation dates across the component medicines.
The financial provisions reinforce Belgium's move towards predictable, structural industry contributions alongside a strict expenditure ceiling, while the reimbursement changes remove administrative steps from simpler applications and address the practical difficulties created by multi-company combination treatments.
Source: Belgian Official Gazette
Link: Loi portant des dispositions diverses en matière de santé (Law containing various health provisions)
Date: 11 August 2026
Source: National Institute for Health and Disability Insurance
Link: Décision du Conseil général sur le budget de l'assurance maladie 2026 (General Council decision on the 2026 health-insurance budget)
Date: 20 October 2025
Source: Belgian Chamber of Representatives
Link: Projet de loi portant des dispositions budgétaires diverses urgentes en matière de soins de santé (Bill containing various urgent budgetary provisions concerning healthcare)
Date: 26 November 2025
