SGK changes calculation criteria for drug reimbursement: 1 percent market share requirement introduced
With a regulation published in the Official Gazette, a 1 percent market share criterion has been introduced for the inclusion of certain drugs in reimbursement calculations.
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The Social Security Institution (SGK) has implemented a new regulation affecting calculation methods in the drug reimbursement system. With the amendment published in the Official Gazette dated October 3, 2026, certain definitions used in reimbursement calculations have been revised, and a 1 percent drug market share criterion has been introduced for specific medications.
Within the scope of the regulation, changes were made to the definitions of "payable unit price range," "internal reference group," and "drug market share." Accordingly, drugs that are newly added to the reimbursement list and possess the lowest unit price in their internal reference group or equivalent group will not be included in the payable unit price range calculation until they reach a 1 percent market share from the date they enter the list.
The market shares of these drugs will be monitored on a monthly basis. Drugs that reach the 1 percent level will be re-included in the relevant calculation.
FIVE-MONTH MONITORING PERIOD
A similar tracking mechanism will be applied to drugs currently in internal reference groups or equivalent groups that have the lowest unit price. Drugs that fail to reach a 1 percent drug market share in any of the last five months of data will be excluded from the payable unit price range calculation.
The market shares of these drugs will continue to be monitored monthly thereafter. Products that reach a 1 percent market share may be included in the calculation again.
Changes were also made to certain expressions in the regulation. The phrase "market shares" in various articles was changed to "Medula data." Thus, data obtained through the SGK's Medula system will be taken as the basis for calculations.
The payable unit price range will be determined based on public prices formed after public institution discounts. The discounted prices per common smallest unit of drugs in the internal reference group or equivalent group will be compared; the range to be applied in reimbursement will be calculated by adding the rate determined by the Health Services Pricing Commission to the cheapest unit price.
The regulation also introduced changes to the commission structure in drug reimbursement processes. The Foundation for Pharmaceuticals, Pharmacy, Health Sciences and Technologies was included in the commission structure, and the number of relevant representatives was increased from 4 to 5. Additionally, it has become mandatory to submit a distribution certificate to the SGK for certain drug applications.