Slovakia’s largest health insurer has tightened the relationship between exceptional medicine reimbursement and its central purchasing arrangements. General Health Insurance Company (Všeobecná zdravotná poisťovňa, VšZP) applied revised criteria from 1 July for medicines, devices and dietetic products funded outside normal categorisation.
Most of the criteria are unchanged from July 2025. The substantive addition concerns medicines for which VšZP centrally procures a comparable treatment. The criteria now explicitly take such procurement into account when assessing exceptional funding, alongside existing conditions concerning clinical need, evidence, previous treatment and financial sustainability.
The practical effect is already visible. Following a central procurement for ranibizumab, VšZP told providers that it would stop approving new exceptional-reimbursement applications for two alternative ranibizumab products in non-categorised or unregistered indications. Where providers continue to use those alternatives, reimbursement is capped at the price of the centrally purchased comparable medicine.
Exceptional reimbursement is a significant part of Slovak access outside the national categorisation system. VšZP reported 2,546 approved and 216 rejected medicine requests during April–June 2026. Rejections most commonly reflected failure to exhaust reimbursed alternatives, insufficient evidence of clinical improvement or pressure on the insurer’s statutory exceptional-medicines budget.
The July change therefore strengthens VšZP’s ability to use central procurement across both routine and exceptional access. It may reduce scope for exceptional funding of alternative products where the insurer has already secured a comparable treatment on preferred commercial terms.
Source: General Health Insurance Company
Link: Kritériá Všeobecnej zdravotnej poisťovne pri posudzovaní úhrady lieku, zdravotníckej pomôcky alebo dietetickej potraviny (General Health Insurance Company criteria for assessing reimbursement of a medicine, medical device or dietetic food)
Date: 1 July 2026
Source: General Health Insurance Company
Link: Štatistické údaje k výnimkám na lieky, zdravotnícke pomôcky a dietetické potraviny (Statistical data on exceptions for medicines, medical devices and dietetic foods)
Date: 15 July 2026
Source: General Health Insurance Company
Link: Usmernenie k centrálnemu nákupu liekov s účinnou látkou Ranibizumab (Guidance on central procurement of medicines containing ranibizumab)
Date: 27 May 2026
