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The Greek pharmaceutical market is facing mounting pressure from domestic funding constraints and an increasingly volatile international environment. Industry leaders are warning that access to innovative medicines is at risk.

Speaking to Euractiv, Olympios Papadimitriou, president of the Hellenic Association of Pharmaceutical Companies (SFEE), said the sector is reaching a breaking point, as rising costs, limited public funding and global policy shifts converge.

“It feels like we’ve reached the limit,” he said. “What concerns us is that we may start seeing more cases where medicines that are already available are withdrawn and fewer new ones coming in.”

His comments come as industry representatives gathered in Athens for SFEE’s general assembly last week, where the association adopted a resolution warning that the current system is becoming unsustainable.

Global pressures reshape the landscape

Beyond national challenges, Papadimitriou pointed to a rapidly shifting global environment as a key factor affecting the Greek market.

As the resolution noted, geopolitical tensions, particularly in the Middle East, are already weighing on trade, investment and economic stability, while broader changes in the global pharmaceutical landscape are adding further uncertainty. At the same time, Europe is struggling to keep pace with international competitors such as the United States and China.

Recent developments in US trade policy are also raising concerns. The US administration has concluded its investigation into the pharmaceutical sector, introducing a 15% tariff on innovative medicines imported from the EU, while leaving open the possibility of significantly higher duties for countries that do not reach bilateral agreements.

According to Papadimitriou, such measures could have indirect but significant consequences for smaller markets, such as Greece. “Companies that want to maintain a presence in the US will have to strike deals,” he said. “The question is at what level and how willing they will be to adjust pricing elsewhere, including in Europe.”

“Just because Greece is not among the countries the US is primarily focused on does not mean companies will accept extremely low prices here simply because we are not directly in scope,” he warned.

“Across Europe, after all, there is extensive external reference pricing, and no company is likely to accept a large gap between prices in first-tier markets and those in second- or third-tier ones,” he explained.

According to Papadimitriou, there has to be some convergence. “This is easier to manage for new medicines, whereas for older products, the situation is already established,” he noted, adding that companies will either take the risk of maintaining lower prices or consider withdrawing them, “which is clearly not an easy decision.”

“For new medicines, however, it is much easier to decide not to launch in a given market at all, to prioritise more favourable ones elsewhere,” he argued.

Fewer medicines, widening gaps

The impact is already being felt. As SFEE’s resolution pointed out, only one in five new innovative medicines becomes available in Greece, a figure that reflects both pricing pressures and the broader funding gap.

Papadimitriou noted that delays and gaps in availability are becoming more pronounced, particularly as companies reassess their market strategies. “We are seeing this across Europe, but more so in Greece,” he said. “And ultimately, this means Greek patients are deprived of innovative treatments.”

In some cases, this leads to increased reliance on alternative procurement channels, such as the state-run Institute of Pharmaceutical Research and Technology (IFET), often at higher cost.

Growing funding imbalance

According to SFEE, the widening mismatch between pharmaceutical expenditure and public funding is at the heart of the issue.

Total pharmaceutical spending in Greece has risen sharply in recent years, while the state budget has increased much more slowly, 10.9 per cent compared to 3.65 per cent, respectively, between 2019 and 2024. As a result, the burden has increasingly shifted onto the industry through mandatory rebates and clawbacks, which now account for a significant share of total expenditure.

This approach is driving a constant and disproportionate increase in mandatory rebates, which are rising by around 20% annually and have now exceeded an average of 58%. Over the past four years, the pharmaceutical industry’s contribution to public pharmaceutical spending has surpassed that of the state, a situation that constitutes a European record, and arguably even a global one, according to SFEE.

Without reform, the situation is expected to worsen. Estimates suggest that total pharmaceutical spending could reach €10.5 billion by 2028, with industry paybacks rising further if the current funding model remains unchanged.

“This is not sustainable,” Papadimitriou said. “We are not just talking about pressure; we are heading towards a dead end.”

Delayed reforms and limited impact

While the government has introduced measures to control expenditure, the industry argues that implementation has been slow and its impact remains unclear.

Papadimitriou cited the example of prescription filters based on the Summary of Product Characteristics (SPCs), which are designed to guide doctors towards appropriate prescribing. “These were supposed to be in place weeks ago, but they haven’t been implemented,” he said. “And even when they are, they won’t be binding; they will simply issue a recommendation.” Doctors will be alerted when a prescription falls outside approved guidelines, but will still be able to proceed.

More broadly, he expressed scepticism about the effectiveness of current policies. “We hear about reforms and measures, but we don’t see results,” he said. “Either they are delayed, or they cannot be measured, or they simply don’t deliver.”

Shared responsibility

The industry is calling for a more balanced approach, centred on increased public funding and a cap on mandatory returns.

“We are asking for co-responsibility,” Papadimitriou said. “In practice, this means setting an upper limit on clawback. If expenditure exceeds that, the state should share the burden.”

SFEE previously proposed a cap on mandatory returns (clawback and rebate), based on 2020 levels when an RRF co-responsibility mechanism was established. At the same time, the association is urging broader structural reforms, including stronger incentives for investment, research and development, and greater use of digital tools to improve efficiency.