CNAS Taken to the CJEU Over Delayed Payments to Pharmacies. What the Institution Has to Say

The European Commission has decided to take Romania to the Court of Justice of the European Union (CJEU), citing "systemic and persistent" delays by the National Health Insurance House (CNAS) in reimbursing the cost of compensated medicines to pharmacies. The Romanian institution rejects these accusations, maintaining that legal deadlines are currently being met and that the proceedings initiated by Brussels relate to old arrears, which a group of pharmacies first complained about back in April 2024.

The payments situation in 2026

According to official CNAS data, as of 8 July 2026, the institution had fully settled reimbursements for medicines dispensed in March. Consumption for the month of April is due to be paid by the end of July, a deadline considered to be on schedule.

CNAS currently has sufficient funds to cover 63% of the amounts required for April. For the remaining shortfall of 827 million RON, the institution has requested support from the Ministry of Finance. CNAS clarifies that the bottleneck is not due to a lack of funds in the budget — 2026 being, according to the institution, the first year in two decades with a balanced budget — but rather to the strict rules of the Budget Law, which cap monthly payments at the credits approved by the Ministry of Finance. For this reason, CNAS has requested that the Health budget be exempted from this capping mechanism.

"The proceedings initiated at European level originate from a complaint lodged in April 2024 by a group of pharmacies. It concerns a historical situation and does not reflect the current reality. Between October 2025 and April 2026, Romania completely eliminated its historical arrears, and in December of last year even managed to pay in advance a portion of its January obligations," CNAS stated.

Medicine consumption growing at an accelerating pace

Beyond the dispute with the CJEU, CNAS is drawing attention to the medium- and long-term sustainability of the Health Fund (FNUASS). Average monthly medicines expenditure has reached 2.4 billion RON, accounting for nearly 40% of the health insurance system's total monthly outgoings.

Over the past three years, this figure has increased by approximately 5 billion RON per year, primarily due to the addition of innovative therapies — which are considerably more expensive — to the reimbursement list. At the same time, the health insurance contribution (CASS), the principal source of funding, has remained fixed at 10%, and revenues are no longer keeping pace with rising expenditure.

Reform called for, with World Bank support

To prevent further financial crises or European legal disputes, CNAS is calling for changes to the legislation governing medicine pricing and reimbursement, following the model of European systems such as those in France or Germany, which are based on flexible negotiations and centralised procurement for large volumes.

The institution has already initiated discussions with pharmaceutical manufacturers and is receiving technical assistance from World Bank experts, with the aim of creating a mechanism that ensures both rapid patient access to new treatments and financial predictability for companies and pharmacies.