Pharmacies Call for Predictable Payments for Subsidised Medicines, Following Reduction of CNAS Delays

Organisations representing pharmacists and pharmacies in Romania are calling on authorities to introduce legislative changes that would guarantee timely payment for subsidised and free-of-charge medicines, following the National Health Insurance House's (CNAS) success in recent months in reducing longstanding reimbursement delays.

In a joint statement, the Romanian College of Pharmacists (CFR), the Association of Pharmacies and Pharmacists of Romania (AFFR), the Association of Pharmaceutical Distributors and Retailers of Romania (ADRFR), the Ethica Independent Pharmacies Association (AFIE), and the Association of Traditional Pharmacies and Practitioners (AFTaP) welcome the steps taken by CNAS, but warn that legislative measures are needed to prevent financial blockages from recurring.

According to the statement, community pharmacies are an essential pillar of access to treatment: every day they dispense subsidised and free-of-charge medicines, pay suppliers, staff salaries, taxes, and contributions to the state, covering all operating costs well before the health insurance system reimburses the amounts owed. The organisations also cite the European Commission's finding that "pharmacies pre-finance the supply of medicines whilst ensuring that patients have timely access to the treatments they need".

The signatories call for legislation to be amended so that funds collected through health insurance contributions are used exclusively for the purpose for which they were gathered and reach CNAS without administrative delays, for the payment of medicines already dispensed to patients.

"When the money exists within the system but does not reach those who have already secured patients' treatment in time, the cost of delays is transferred onto pharmacies. They are forced to bear additional financing costs, sustain their operational cash flows from their own resources, and continue to meet payroll obligations for professionals, as well as payments to suppliers and tax authorities," the document states.

Industry representatives highlight that Romania's recent success in reducing payment delays demonstrates that a predictable reimbursement system, compliant with statutory deadlines, is achievable.

The statement was issued after the European Commission decided to refer Romania to the Court of Justice of the European Union (CJEU) over its longstanding delays in medicines payments.

"The problem is no longer one of funding, but of budgetary mechanism"

The signatory organisations note that a recent message from CNAS, issued following the European Commission's decision, indicates that the necessary funds exist but that the current legislative framework does not allow them to be deployed quickly enough: "The financial resources exist, but the current legislative framework does not allow them to be used with sufficient flexibility to meet statutory payment deadlines. Under these circumstances, the problem is no longer one of funding, but of budgetary mechanism."

Pharmacy representatives further state that administrative delays generate additional costs for operators in the sector, who are obliged to finance day-to-day activities from their own resources whilst awaiting reimbursements from the insurance system.

Proposed legislative changes from pharmacists

The Romanian College of Pharmacists and the representative associations propose:

• The use of available funds in the National Unique Fund for Social Health Insurance (FNUASS) for the payment of outstanding obligations without administrative delays;
• Exempting the FNUASS budget from mechanisms that limit monthly payments when financial resources are available;
• Prioritising the use of health contributions collected for the exact purpose for which they were raised, so that FNUASS funds are available on time for medical services and medicines;
• A predictable reimbursement schedule, enabling payments to pharmacies by no later than the 15th of each month, with the medium-term objective of making these payments even earlier.

"Such a mechanism would not merely represent a support measure for pharmacies. It would ensure continuity of medicine supply, stability across the entire pharmaceutical chain, pharmacies' continued ability to meet their obligations to suppliers, employees, and the state, and, most importantly, uninterrupted patient access to the treatments they need," the statement notes.

A call for a predictable and sustainable system

The organisations consider that the European proceedings regarding longstanding payment delays should be used as an opportunity for reform: "The European proceedings concerning historical delays must be seen as an opportunity to definitively correct the mechanisms that allowed these situations to arise."

They express their willingness to work with CNAS, the Ministry of Health, the Ministry of Finance, patient organisations, and the pharmaceutical industry to find stable legislative solutions aligned with European practices: "We reaffirm our commitment to remaining responsible partners to the authorities in building a modern, predictable, and sustainable financing mechanism that protects patient access to treatment and the stability of Romania's healthcare system."