In brief

  • The joint order of the Ministry of Health and of the National Health Insurance House changes 39 positions in the list of medicines reimbursed under the national health programmes: 24 are amended, 8 are added and 7 are repealed, across seven programmes and subprogrammes, from HIV/AIDS to dialysis.
  • The reimbursement price is what the insurance house pays, not what the patient pays. The amount seen at the pharmacy sits in the last column, „contribuția maximă asigurat”, the maximum contribution of the insured person, and for pazopanib 400 mg the new generic takes it from 25.642801 lei per tablet to zero.
  • The order was published on 7 September 2026, yet it provides that it applies „starting with September 2026”, that is including the six days before publication.
Act: Order of the interim minister of health no. 1.212/2026 and of the president of the National Health Insurance House no. 1.566/2026
Published: Official Gazette of Romania (Monitorul Oficial) no. 758 of 7 September 2026
In force from: 7 September 2026, on publication, although the text says „starting with September 2026”

The list of medicines that the insurance house reimburses for patients in the national health programmes changes in 39 positions. The joint order signed by the Ministry of Health, under number 1.212 of 31 August 2026, and by the National Health Insurance House, under number 1.566 of 28 August 2026, amends Annex no. 2 to Order no. 1.605/875/2014, that is precisely the list of commercial names and reimbursement prices that pharmacies and hospitals use when they dispense medicines under the programmes. It is the second update of the same list in less than a month, after the order of 11 August 2026, which touched 79 positions.

The first thing to clear up is what „reimbursement price” means, because the name is misleading. It is not the sum the patient takes out of their pocket. It is the sum the insurance house pays the pharmacy or the hospital for one therapeutic unit, that is for a tablet, a capsule, an ampoule or a vial. What the patient pays appears in a separate column of the list, called „contribuție maximă asigurat/U.T. – farmacii comunitare”, the maximum contribution of the insured person per therapeutic unit in community pharmacies, and it represents the difference between the retail price of the product and what the insurance house covers. That is where you read whether the order changes anything at the counter.

The changes fall into three categories. Twenty-four existing positions get new data, eight new positions are added to the list, and seven positions in the national oncology programme are repealed, that is they leave the list. The positions taken out are identified only by their serial numbers, 226, 238, 246, 258, 274, 732 and 777, without the name of the medicine, so a patient cannot find out from the order whether their brand has disappeared.

Seven programmes are touched. The national communicable diseases programme, the HIV/AIDS and post-exposure treatment subprogramme, gets nine changes to antibiotics. The national oncology programme gathers the most movement: thirteen positions amended, four added and seven repealed. Then there are the rare diseases programme, in the haemophilia and thalassaemia subprogramme, bone marrow and kidney transplantation, the dialysis programme and the subprogramme for the treatment of drug dependence.

The most visible novelty for cancer patients is the appearance of four new positions. One is a generic pazopanib from Dr. Reddy’s Laboratories, a pack of 60 film-coated 400 mg tablets, with a reimbursement price of 93.270166 lei per tablet and a contribution from the insured person of zero. The other three are ixazomib, under the commercial name Ninlaro, in strengths of 2.3 mg, 3 mg and 4 mg, all at 6,333.453333 lei per capsule and all with a zero contribution. The pack of three capsules means a reimbursement price of 19,000.36 lei, the largest sum in the whole order.

What it changes in practice

The most concrete effect is seen with pazopanib, an oral cancer medicine. The order sets for Votrient and for Pyzypi a reimbursement price of 111.924199 lei per tablet and a contribution from the insured person of 25.642801 lei per tablet. For a pack of 60 tablets, that means 1,538.57 lei paid by the patient at the community pharmacy. For Pazopanib Teva the contribution is 1.714467 lei per tablet, so 102.87 lei per pack. For the new Pazopanib Dr. Reddy’s, the contribution is zero. The same substance, the same strength, the same pack of 60, and the difference between the ends of the range is 1,538.57 lei.

The same goes for the dialysis programme. The order introduces Paricalcitol Heaton, 1 microgram soft capsules, pack of 28, at a reimbursement price of 4.896071 lei per capsule and with a zero contribution. In the same move, Zemplar, the reference product with the same substance and the same strength, stays with a contribution of 4.142929 lei per capsule, that is 116.00 lei for the pack of 28. A dialysis patient who gets a prescription for Zemplar pays those 116 lei; the one who gets Paricalcitol Heaton pays nothing.

In the HIV/AIDS subprogramme, the order rearranges all the 1 gram ceftriaxones. The reimbursement price becomes 19.953360 lei per vial for seven positions, but the contribution of the insured person differs enormously from one product to another: 0.684640 lei per vial for Cefort in packs of 10 vials, 1.516640 lei for Seftrion in the single-vial pack, 6.886640 lei for Cefort in the single-vial pack and 19.296640 lei for Ceftriaxona-MIP. The last sum is almost 28 times larger than the first. On a pack of 10 vials, the difference between Ceftriaxona-MIP and Cefort reaches 186.12 lei.

The rest of the amendments move nothing in the patient’s pocket, because they come with a zero contribution: Haemate P in haemophilia, 1,357.890000 lei for the pack of 500 units, Mialgin in kidney transplantation, 14.336000 lei per ampoule, Metadon Bioeel in the treatment of drug dependence, 2.550800 lei per tablet, and Cecenu, 40 mg lomustine capsules in oncology, 114.477500 lei per capsule. Meropenem Besmax enters two programmes at once, HIV/AIDS and bone marrow transplantation, with the same figures in both: 46.578000 lei reimbursed per vial and a contribution of 3.095000 lei, so 30.95 lei for the pack of 10 vials.

What has changed compared with the previous situation

The order does not print the old values, only the new content of each position. Anyone who wants to compare has to open the previous consolidated list, which means following all the amending orders back in time. The mechanism can, however, be reconstructed from the text, and the mechanism explains the change. The same reimbursement price lists from the national programmes feed a separate calculation, the clawback tax: the 5,469 type I and type II medicines for the second quarter of 2026 got their label 16 days after the payment deadline.

Annex no. 1 to Order no. 1.605/875/2014 says, in Article 1(1), that the reimbursement price for medicines dispensed through open-circuit pharmacies is set by applying 120% to the lowest maximum retail price including VAT per therapeutic unit, calculated for each substance, pharmaceutical form and strength. Paragraph (2) adds a correction: if a product’s own price is lower than the result of that calculation, then its own price becomes the reimbursement price. In practice, the cheapest product in the group sets the threshold, and the others are reimbursed at 120% of it.

Three of the eight new positions introduced now are exactly the products that bring the threshold down. Seftrion in the pack of 50 vials, position 537, has a reimbursement price of 16.627800 lei per vial, and 16.627800 multiplied by 1.2 gives exactly 19.953360, that is the new value for all the other 1 gram ceftriaxones in the subprogramme. Paricalcitol Heaton, position 109, has 4.896071 lei per capsule, and 4.896071 multiplied by 1.2 gives exactly 5.875285, that is the new reimbursement price of Zemplar. Pazopanib Dr. Reddy’s, position 825, has 93.270166 lei per tablet, and 93.270166 multiplied by 1.2 gives exactly 111.924199, that is the new value for Votrient, Pyzypi and Pazopanib Teva. The three pairs of points in the order are not independent: each new product pulled into the list automatically recalculates the prices of its neighbours.

Compared with the previous order, the one of 11 August 2026, which touched 79 positions in eight programmes, the update of 7 September is about half the size, 39 positions in seven programmes. Article 2(2) of the base order requires the list to be updated quarterly or whenever needed. In practice, the rhythm has become monthly.

Advantages and disadvantages

What it improves

  • Three substances gain a variant with a zero contribution: pazopanib 400 mg, paricalcitol 1 microgram and ceftriaxone 1 gram in the large pack. For the patient who receives the new product, payment at the pharmacy disappears.
  • The entry of a cheaper product into a group pulls down the reimbursed price for the whole group, so the spending of the insurance fund falls too, not only that of the patient.
  • Ixazomib, an oral treatment for multiple myeloma, gets all three strengths at once, 2.3 mg, 3 mg and 4 mg, which allows the dose to be adjusted without one form being missing from the list.
  • Meropenem Besmax enters two programmes simultaneously, with the same figures, so no reimbursement differences arise between a patient with HIV and one with a bone marrow transplant treated with the same antibiotic.
  • The monthly update shortens the interval in which the list lags behind the real prices in the national catalogue.

What remains a problem

  • The seven positions repealed in oncology appear only as numbers. Neither the patient nor the pharmacist learns from the order which medicines have left the list.
  • The date of application, „starting with September 2026”, precedes the publication of 7 September 2026 and leaves six days in which nobody knows which price applies.
  • The contribution remains very different from one brand to another for the same substance. For ceftriaxone 1 gram, the ratio between the most expensive and the cheapest variant is almost 28 to one, and the choice does not belong to the patient, but to the prescriber and to the pharmacy’s stock.
  • The order does not publish the previous values, so the direction of the change, up or down, cannot be read from the act.
  • Ninlaro stays at 19,000.36 lei for the pack of three capsules. The contribution is zero, but access depends on the programme’s budget, and the order says nothing about that.

Practical advice

  1. Ask the pharmacist to tell you, before dispensing, what the contribution is for the product on the prescription. It is the only sum you pay and it differs between brands of the same substance.
  2. If you take pazopanib 400 mg, ask your treating doctor whether they can prescribe the variant with a zero contribution. The difference reaches 1,538.57 lei on a pack of 60 tablets.
  3. If you are in the dialysis programme and take paricalcitol, compare the two variants in the list. One comes with 116.00 lei for the pack of 28 capsules, the other with zero.
  4. Keep the receipt and the prescription for medicines dispensed between 1 and 7 September 2026. If a contribution other than the one in the order was charged to you, you have grounds to complain to the health insurance house.
  5. Check the consolidated list on the website of the National Health Insurance House before going to the pharmacy, especially if your treatment is oncological. Seven positions were taken out without being named.
  6. Do not change the brand of your medicine on your own. Substitution is done by the doctor or the pharmacist, within the limits of the prescription, and a change made on your own initiative may also mean a different dose.
  7. If the pharmacy asks you for a contribution higher than the one in the list, ask for the explanation in writing. The column in the annex is called „maximum contribution”, so it cannot be exceeded.

Frequently asked questions

Is the reimbursement price what I pay at the pharmacy?
No. The reimbursement price is the sum the insurance house pays the pharmacy or the hospital for one therapeutic unit. What you pay appears in the column „contribuție maximă asigurat”, the maximum contribution of the insured person, in the same list, and it may be zero.
What is a therapeutic unit?
It is the smallest piece of the pack to which the price is referred: a tablet, a capsule, an ampoule or a vial. The list also shows how many units each pack holds, so the sum per pack is obtained by multiplying.
From when do the new prices apply?
The order was published on 7 September 2026 and provides that it applies „starting with September 2026”. The two statements do not overlap, because an order of this kind enters into force on publication or on a later date, not earlier. For 1 to 6 September 2026 the situation remains unclear.
Which medicines were taken out of the oncology programme?
The order repeals positions 226, 238, 246, 258, 274, 732 and 777, but does not name them. The names can be found only by comparing with the previous consolidated list, published by the National Health Insurance House.
If my medicine has been taken out of the list, am I left without treatment?
Not necessarily. A position leaving the list means that this commercial name is no longer reimbursed under the programme. The substance usually remains available under other commercial names in the same group. Talk to the doctor who follows your case.
Why do I pay a contribution if I am in a national programme?
Because in open-circuit pharmacies the fund reimburses a reference value calculated from the cheapest product in the group. If you are dispensed a product more expensive than the reference, you bear the difference, within the sum entered in the list.
How is the reimbursement price calculated?
Annex no. 1 to Order no. 1.605/875/2014 provides in Article 1(1) that 120% is applied to the lowest maximum retail price including VAT per therapeutic unit in the group. Paragraph (2) states that, if a product’s own price is lower than the result, that own price becomes the reimbursement price.
Does the order also affect medicines dispensed in hospital?
Yes. The list applies to patients in the national programmes both in outpatient care and in hospital. For closed-circuit pharmacies, Article 2 of Annex no. 1 to the base order provides that the reimbursement prices cannot exceed the corresponding wholesale prices, to which VAT is added.
How often does the list change?
Article 2(2) of Order no. 1.605/875/2014 requires a quarterly update or one whenever needed. In 2026 the real rhythm has been monthly: the previous order was published on 11 August 2026 and touched 79 positions.
Who signed the order?
For the Ministry of Health it was signed, by delegation, by state secretary Stela Firu, on behalf of the interim minister of health. For the National Health Insurance House it was signed by president Horațiu-Remus Moldovan.

Errors and inconsistencies in the published text

  • Article II, the date from which the order applies. The text says that the order „se publică în Monitorul Oficial al României, Partea I, și intră în vigoare începând cu luna septembrie 2026”, that it is published in the Official Gazette of Romania, Part I, and enters into force starting with September 2026, and publication took place on 7 September 2026. Article 12(3) of Law no. 24/2000 on the rules of legislative drafting provides that normative acts of this kind enter into force on the date of publication in the Official Gazette of Romania, and that if entry into force is to happen otherwise, a later date must be provided in the text. „September 2026” is not a date later than publication, but an interval that begins six days before it. A pharmacist reading the act in good faith can reach two different conclusions for prescriptions dispensed between 1 and 6 September 2026: either the new prices apply, or the old ones do. The difference is in money and the patient bears it, for example 4.142929 lei per capsule for Zemplar, that is 116.00 lei for a pack of 28. The same wording appeared in the previous order too, published on 11 August 2026 for „August 2026”, so it is not an isolated slip, but a pattern.

Editorial analysis

Read from beginning to end, the order looks like a string of codes and decimals with no connection between them. The connection is there and it shows only when you do the arithmetic. Three of the eight new positions are products that bring down the threshold of their group, and the rest of the changes in those groups are the arithmetical consequence of their entry. Seftrion in the pack of 50 vials comes at 16.627800 lei per vial, and 16.627800 multiplied by 1.2 gives 19.953360, exactly the reimbursement price that the order assigns to the other seven 1 gram ceftriaxones. Paricalcitol Heaton comes at 4.896071 lei per capsule, and 4.896071 multiplied by 1.2 gives 5.875285, exactly the new value of Zemplar. Pazopanib Dr. Reddy’s comes at 93.270166 lei per tablet, and 93.270166 multiplied by 1.2 gives 111.924199, exactly the new value for Votrient, Pyzypi and Pazopanib Teva. Points 1 and 2, 9 and 10, 3 and 5 are not separate lists, but three pairs of cause and effect.

That should be said in the order, not deduced by the reader. A patient who sees that the price of Zemplar has changed has no way of learning from the text that the reason is the appearance of a cheaper generic one position below, and even less that there is now a variant with a zero contribution for the same substance. The information that would actually change their bill, the existence of the alternative, is the best hidden thing in the whole act.

The second observation concerns the relation between the rhythm of the administration and the rhythm of the patient. The president of the National Health Insurance House signed on 28 August 2026, the interim minister of health on 31 August 2026, and publication came on 7 September 2026, seven days after the last signature. In those seven days, pharmacies dispensed prescriptions according to the old list, even though the order claims its effects from the beginning of the month. The time the administration takes between signature and publication becomes, in practice, a zone in which the patient does not know what they are paying. The same delay appeared in August as well, when the CNAS signature was dated 30 July and publication came on 11 August.

What should be changed

  • A fixed date of application, not a month. Replacing the formula „starting with September 2026” with a calendar date later than publication would close the ambiguity for the first days of the month and take reimbursement claims out of the zone open to interpretation.
  • The names of the medicines at the repealed positions. The seven positions taken out of oncology should appear with the commercial name and the CIM code, so that the patient learns from the order, not from a comparison of lists, whether their product has left.
  • A column with the previous value. Adding the old price next to the new one, at the amended positions, would show the direction of the change without forcing anyone to reconstruct the consolidated list.
  • Publication of the consolidated list on the same day as the order. The National Health Insurance House could upload the updated version of Annex no. 2 when the order appears in the Official Gazette of Romania, not a few days later.
  • Marking the groups in which a variant with a zero contribution appears. A sign in the list where a product with no payment at the counter exists would help the prescribing doctor and the pharmacist tell the patient that there is a choice.
  • A shorter interval between signature and publication. Ten days from the first signature, that of the National Health Insurance House on 28 August 2026, to publication on 7 September 2026, and twelve days in the case of the previous order, signed on 30 July and published on 11 August 2026. Part of the month for which the list applies goes by before the list exists in public.

Original text of the legal act

The text below is reproduced in Romanian, the official form of publication.

The full text, as published in the Official Gazette of Romania

Official Gazette of Romania no. 758 of 7 September 2026 16 pages PDF, 117 KB the act starts on page 2

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This article is for informational purposes only and does not constitute legal advice. For specific situations, consult a licensed attorney or tax advisor.