Belgian drug cost crisis needs tough medicine, Vandenbroucke prescribes remedy

As pharmaceutical spending accelerates beyond the limits of Belgium’s healthcare budget, the government is laying the groundwork for a structural shift in how drug costs are managed and who carries the burden.

Rather than cutting in isolation, Health Minister Frank Vandenbroucke is proposing a new multiannual pharmaceutical framework that seeks to stabilise spending by sharing responsibility across the healthcare ecosystem of industry, prescribers, patients, insurers, and pharmacists.

Presented in response to parliamentary questions and elaborated in recent remarks to the pharmaceutical sector, the proposal sets a clear boundary; pharmaceutical spending should not exceed 17.3 per cent of the national healthcare budget. It also lays out how different stakeholders will be asked to contribute to achieving that target.

With spending projected to grow by 7 to 8 per cent annually, far above the 4.5 per cent health budget margin in 2026, the government argues that inaction would crowd out essential investments in healthcare priorities and widen inefficiencies.

“This is not about short-term savings,” Vandenbroucke told MPs. “It’s about designing a system that can support innovation, deliver equitable access, and remain financially viable in the years ahead.”

Tying pharma to growth

The centrepiece of the proposed framework is a ceiling for pharmaceutical expenditure, set at 17.3 per cent of the net healthcare budget. Rather than a rigid amount, the idea is to tie pharmaceutical spending to the overall growth of the healthcare system, creating what the minister described as a “mutual reassurance mechanism.”

In a separate speech to pharma.be last month, Vandenbroucke said, “To the sector, it provides credibility that pharmaceutical spending will grow in proportion with the healthcare budget. To the government, it ensures that pharmaceuticals will not absorb a disproportionate share.” This, he argued, is about more than arithmetic. It is a way of embedding predictability and shared responsibility into a system under strain.

Distributing the burden

But with predictability comes pressure. In practical terms, maintaining the 17.3 per cent ceiling in 2026 requires an adjustment of around €466 million. The government’s proposal distributes this effort across the ecosystem.

The pharmaceutical industry would contribute the largest share, an estimated 57 per cent, through a reinforced clawback mechanism and budgetary guarantees.

Patients would see modest increases in co-payments, but with strong protections: a minimum of €1 per box for people with increased reimbursement status (BIM), and €2 for others, affecting only medications that are currently priced extremely low.

Other actors, including prescribers, insurers and pharmacists, would be asked to contribute through behavioural and structural reforms.

Political reactions

The principle of shared responsibility dominated the debate at the Health Commission. MP Jan Bertels of Vooruit stressed the importance of balance, welcoming the proposal as long as it remained fair. “It is essential that the efforts asked of everyone are reinvested,” he said, pointing to the planned expansion of the maximum out-of-pocket ceiling (MAF) as a tangible example.

Vandenbroucke confirmed that revenues from the increased co-payments would not be absorbed into the general budget but would be used to improve coverage of allergy medications, contraceptives, and other treatments not currently covered under the MAF.

Other MPs were more critical, particularly of the patient contribution. Caroline Désir (PS) and Ludivine Dedonder (PS) questioned the fairness of raising co-payments for medications prescribed by doctors, such as statins and proton-pump inhibitors.

“It’s not the patients who need sensitising, it’s the prescribers,” Dedonder said. Irina De Knop (Open VLD) and Kathleen Depoorter (N-VA) focused on the risk of underinvesting in innovation and early access. “Part of the savings must absolutely be reinvested into innovation,” said De Knop, who also urged caution against arbitrary caps.

Fast-track access

This concern was addressed directly in the government’s proposal, which includes the launch of a new fast and early access procedure for promising medicines. In his pharma.be speech, Vandenbroucke described this as a long overdue reform.

“We are currently finalising its design,” he said, explaining that companies will be allowed to apply for early market access, in some cases even before formal marketing authorisation, in exchange for a fixed, financially attractive fee.

To avoid unintended pressure on the core pharmaceutical budget, this pathway will be financed through a separate, clearly defined budget envelope.

This dual-envelope model, one for routine pharmaceutical expenditure, another for fast-track access, is central to the framework’s architecture.

The main envelope must also absorb costs related to shortages of essential medicines, which have become a growing problem in Belgium and across the EU.

“The more inefficiency we tolerate, the fewer new and valuable medicines we can afford to introduce,” the minister said.

He cited the example of cholesterol-lowering drugs, where spending has surged to over €250 million annually, driven both by over-prescription and the rapid uptake of expensive new-generation therapies. The current system, he argued, is not equipped to critically evaluate such cost increases in terms of proportional health benefit.

Efficiency, as defined by the Commission on Healthcare Priority Objectives, is the conceptual backbone of the reform. It is not just about saving money, but about ensuring that every euro spent contributes meaningfully to better health outcomes. This applies not only to medicines, but to how the entire system functions, from antibiotic prescribing and hospital formularies to how insurers monitor the application of reimbursement criteria.

A broader reform agenda

Beyond budgetary and access reforms, the government is also taking steps to address the structural causes of medicine shortages. Belgium is pushing for changes at the European level, particularly within the proposed Critical Medicines Act.

Vandenbroucke supports linking procurement practices to sustainability and EU-based manufacturing, and has advocated for stronger coordination of stockpiling policies to avoid imbalances between large and small member states.

Domestically, Belgium plans to exempt certain critical low-cost medicines from mandatory price cuts and to strengthen sanctions against companies that withdraw supply from the Belgian market while continuing to serve others.

The minister’s overarching message, both in Parliament and to the pharmaceutical sector, is that sustainability and innovation are not opposing goals.

But achieving both requires difficult decisions and mutual trust. “We are in a real structural dialogue,” he told pharma.be. “We meet, we discuss, we disagree, we try to find agreements. There is very, very much at stake for the next few years, for patients, for the industry, for everybody.”

The final shape of the multiannual pharmaceutical framework will be determined in the coming weeks, as the RIZIV Insurance Committee prepares to reach a consensus ahead of the 2026 budget.

[Edited by Vasiliki Angouridi, Brian Maguire]