The payback bill remains high: for companies supplying the SSN 3 billion to be paid in 2026

The bill for the companies that supply the health service every day with valuable drugs and medical devices (from syringes to CT scans) is still likely to remain rather steep. Despite the adjustments envisaged in the budget manoeuvre now being examined by the Senate to be passed by the end of the year, drug and biomedical companies next year - unless changes are made in extremis (there is no shortage of amendments) - could pay around 3 billion in payback. This is the now well-known cut-off that both pharmaceutical companies (for several years now) and biomedical companies (more recently) have to pay every year in the event that NHS expenditure exceeds the ceiling, something that happens punctually every year. This will also be the case in 2026, even though, as has been said, the spending ceilings have just been raised by the manoeuvre: a small shift - +0.25% for expenditure on drugs, which rises from 2026 to 15.5% of the Health Fund, and +0.20% for the biomedical sector, which thus reaches 4.60% of the same Fund - that is by no means sufficient to stem a now uncontrollable expenditure that is growing much more than the ceilings. This is demonstrated by the simulations of the Court of Auditors in its detailed hearing on the budget law. But let us look in detail at the numbers and possible developments for the two sectors.

The Court of Auditors, on the basis of the pharmaceutical expenditure data for the first four months of this year collected by the Medicines Agency, estimates that expenditure (including contracted pharmaceuticals, direct purchases, and medical gases) will close at 24.097 billion in 2025, compared to 21.089 billion available on the basis of the new 15.55% ceiling on the Health Fund. In practice, the overrun could be 3 billion, but if one looks at the two silos from which the pharmaceutical ceiling is composed - direct (hospital drugs) and contracted (pharmacies) - one discovers that the former could overrun by 3.8 billion, while the latter could have a surplus (as every year) of 793 million. In this way, the payback borne by pharmaceutical companies - calculated on the purchases of direct expenditure - would stand at 1.9 billion (half of 3.8 billion), below the threshold of 2 billion already exceeded in 2024. A figure that is still very high, which has prompted Farmindustria, among others, to call for a further upward adjustment of the ceiling, at least 0.50 per cent (instead of 0.25 per cent), already in this manoeuvre. And in fact, even in the majority there is no shortage of amendments on this front, such as the one signed by senators Lotito and Paroli of Forza Italia, which envisage an increase of 0.50% in 2026, 0.60% in 2027 and 0.70% from 2028. The margins are tight for now, but it will be seen in the next few days whether there is a glimmer of hope.

The accounting judiciary also makes a simulation for expenditure on medical devices, this time taking the 2024 expenditure (the last certified) and applying to it the new expenditure ceiling that in 2026 will rise from 4.4% to 4.6% on the Health Fund. And so it turns out that even with this small breath of fresh air, the ceiling would be exceeded by no less than 2.214 billion, and thus the bill for businesses would be 1.1 billion. A blow that comes on top of the even heavier one relating to the arrears still unpaid by the companies for the years 2019-2024, which cubes 10 billion in overruns, half of which is always borne by the industries. Monstrous figures on which a signal is expected from the government, which is currently silent, as well as on the redesigning of future governance, on which the Ministry of Health is working with a technical round table that has not yet been convened. In the manoeuvre, there is no shortage of amendments, again from the majority, which among other things envisage excluding from the payback companies with a turnover of less than 5 million and increasing the spending ceiling by 0.2% for the years 2027 and 2028 as well.