Bills for companies that supply drugs and valuable medical equipment (from syringes to CT scans) to the Health Service on a daily basis are still quite high. Although planned adjustments in the budget package are now being vetted by the Senate for approval by the end of the year, drug and biomedical companies could pay about $3 billion in refunds next year, unless there are last-minute changes (there is no shortage of amendments). This is a trap that pharmaceutical companies (in recent years) and biomedical companies (in recent years) have now known they have to pay every year if NHS spending exceeds expected spending limits, which happens every year. And this will also be the case in 2026 even if, as already mentioned, the spending ceiling has just been raised by the budget: small changes – +0.25% for pharmaceutical spending which increases from 2026 to 15.5% of the Health Fund and +0.20% for biomedicine which thus reaches 4.60% of the same Fund – are simply not enough to stem the now uncontrollable spending which amounts to much more than the upper limit. This is demonstrated by a simulation of the Court of Auditors in a detailed hearing on the budget law. But let’s look in detail at the figures and possible developments in these two sectors.
The Court of Auditors, based on pharmaceutical expenditure data for the first four months of the year collected by the Medicines Agency, estimates that expenditure (including affiliates, direct purchases and pharmaceutical gas) will reach 24.097 billion in 2025 compared with 21.089 billion available under the new ceiling of 15.55% on the Health Fund. In practice, overspending can be as high as 3 billion, but if you look at the two silos that make up the pharmaceutical sector – direct (hospital medicine) and its affiliates (pharmacies) – you will find that the first can reach more than 3.8 billion, while the second may have a surplus (like every year) of 793 million. In this way, the returns paid by pharmaceutical companies – calculated on the basis of direct shopping purchases – would amount to 1.9 billion (half of 3.8 billion), below the 2 billion threshold already exceeded in 2024. A figure that is still very high and prompted Farmindustria, among other things, to ask in this budget for a further increase in the ceiling, at least 0.50% (instead of 0.25%). And in fact, even among the majority, there is no shortage of this, as the amendment signed by senators Lotito and Paroli of Forza Italia stipulates increases of 0.50% in 2026, 0.60% in 2027, and 0.70% starting in 2028. The margins for now are very narrow, but we will see in the present whether there is a glimmer of hope in this direction.
The accounting judicial body also carried out a simulation of health equipment spending, this time taking spending in 2024 (latest certified) and implementing a new spending ceiling which in 2026 will increase from 4.4% to 4.6% on health funds. And it turns out that even with this little bit of fresh air, the ceiling will be exceeded by 2.214 billion so that the bill that must be paid by the business world is 1.1 billion. The increasingly heavy blow is related to the backlog that has not yet been paid by companies in 2019-2024, which amounts to an overrun of 10 billion, half of which is still borne by the industry. The very large figures that we hope are a signal from the Government which is currently still silent, as well as a redesign of future governance which is being worked on by the Ministry of Health with a technical table that has not yet been drawn up. Here too, there is no shortage of amendments from the majority that include, among other things, excluding companies with turnover under 5 million from its returns and increasing the expenditure ceiling by 0.2% also for 2027 and 2028.
