Greece’s pharmaceutical sector is sounding the alarm over what industry leaders describe as an unsustainable financing model, one that has quietly shifted the burden of public drug spending from the state onto the companies themselves, with patients increasingly caught in the middle.
In a resolution passed at the general assembly of the Hellenic Association of Pharmaceutical Companies (known by its Greek acronym, SFEE), industry representatives warned that mandatory rebates, known as clawbacks have now surpassed 58% on average in Greece. The clawbacks are a cost-containment mechanism, used across several EU member states, that requires drug makers to return a portion of their revenues to the state when pharmaceutical spending exceeds a predefined budget cap. That figure has been climbing at roughly 20% per year, and for the past four years, the industry’s net financial contribution to public drug coverage has exceeded that of the Greek government itself. SFEE described this as an unprecedented situation within the EU.
The numbers behind that claim are stark. Between 2019 and 2024, public funding for pharmaceutical expenditure grew at just 3.65%, while total drug spending in the country rose by 10.9%. The gap between the two has been filled almost entirely by the industry, through the clawback system.
A Patient Access Crisis Hidden in Plain Sight
The financial squeeze has a direct human cost. According to SFEE, only one in five new medicines approved at the European level is actually made available to patients in Greece. The country simultaneously records the lowest prices for branded drugs in Europe and the highest clawback rates on the continent. The result is a paradox: drugs are cheap on paper, but many patients simply cannot get them.
This dynamic is particularly troubling given the broader global context. The conflict in the Middle East, ongoing supply chain disruptions, and shifting international trade policies — including the Trump administration’s “Most Favored Nations” pricing proposal, which would peg U.S. drug prices to the lowest rates paid by a select group of countries — are adding pressure to an industry already stretched thin, according to SFEE. European pharmaceutical competitiveness, SFEE noted, continues to lag behind the United States and China despite recent legislative efforts at the EU level.
The Bill Is Still Growing
A study by consulting firm Deloitte projects that Greece’s total pharmaceutical expenditure could reach 10.5 billion euros by 2028; a trajectory that, without structural reform, would push clawback obligations even higher. Industry representatives point to the absence of effective prescription monitoring and a lack of shared accountability between the state and the private sector as key drivers of runaway spending.
Currently, there is no binding framework that holds prescribers, insurers, or patients accountable for the cost implications of treatment choices; a gap that, the industry argues, creates little incentive for rational spending.
What the Industry Is Asking For
SFEE’s resolution outlines a series of reforms it says are urgently needed. These include a gradual increase in public pharmaceutical funding, greater use of digital tools to monitor and manage spending, and critically the introduction of a cap on clawback payments, which currently have no upper limit. The association is also calling for a formal co-responsibility model: a shared framework in which both the government and the pharmaceutical industry have defined obligations and limits.
On the investment side, SFEE is pushing for stronger incentives for research and development in Greece, as well as expanded partnerships with international research institutions and academic bodies. The association acknowledges some positive recent steps, including new investment instruments and the use of EU Recovery Fund resources, but says these measures fall short of what is needed.
2026 as a Crossroads
The SFEE resolution frames 2026 as a pivotal year, a moment when the decisions made by Greek policymakers will determine the long-term trajectory of the country’s health system. Particular emphasis is placed on linking pharmaceutical innovation to domestic manufacturing and on expanding the use of generics and biosimilars, which are lower-cost versions of brand-name and biological drugs respectively.
Despite the mounting pressures, Greece’s pharmaceutical sector remains a significant economic force. The industry supports approximately 119,000 jobs and contributes around 3.1% of the country’s gross domestic product.
The core message from industry leaders is blunt: Greece must choose between investing in a modern, sustainable health system or preserving a distorted status quo that, they argue, undermines both economic efficiency and patient care. As SFEE put it in its resolution, the decisions of the coming months are expected to provide the answer.
