Following the accession of Minister Kamil Šaška in accordance with his declaration on streamlining processes and implementation of systematic solutions of MZ SR, he also took intensive steps in the area of recovery of compensation differences. In 2025 the Ministry of Health of the Slovak Republic issued decisions in total value25 million euros, the highest volume in history. At the same time, 22 new proceedings were initiated and should have been opened already between 2018 and 2022.
According to the latest analysis of the Value for Money Service (EOU), monitoring of drug expenditure and related contracts with drug manufacturers is actively addressed in Slovakia, including the recovery of so-called drawbacks from producers, which arise e.g. from various discounts, reimbursement limits and drug price agreements. This process is part of the control of medicinal expenditure and the effort to ensure fair funding in the public health insurance system. MZ SR from the position of central government issues decisions determining the amount of the settlement difference. It is not the responsibility of MZ SR to act on behalf of health insurance companies and to recover funds that belong to them by decision issued by MZ SR.
MZ SR took systematic measures in 2025 to close the equalisation gap from 2018 - 2022 while increasing transparency in the back payment of medicines. The objective is to ensure consistent protection of public resources and effective management of medicinal expenditure.
Balancing differences: following years of inactivity, an active approach comes
Balancing differences arise when the real reimbursement of health insurance companies for a medicinal product exceeds their conditional reimbursement. In that case, the manufacturer of the medicinal product is obliged to pay the difference to the health insurance companies.
According to the data of the Slovak Ministry of Health, health insurance companies were entitled to compensation differences of EUR 53 million for the period 2018 - 2022. The success of their recovery has been very low in the past. The first decisions were issued only in 2023, amounting to EUR 7 million. No procedure was finalized in 2022.
Back payments: a more efficient mechanism after the amendment of the Act
Since 2022, a new refund mechanism has been in place under the terms and conditions of reimbursement (MEA). The amendment introduced an obligation on the manufacturer to pay the difference between the actual reimbursements for the medicinal product and the condition agreed in the contract.
In contrast to the countervailing differences, there is no need to initiate administrative proceedings. After sending a call from MZ SR, the manufacturer automatically shows the return payment to health insurance companies.
Increased transparency and control
MZ SR is preparing a measure on the basis of which it will publish data for back payments and settlement differences annually. The aim is to strengthen transparency, predictability and public control in handling public health insurance funds.
The Ministry of Health declares that control of drug expenditure is one of its priorities. By actively catching up past commitments and setting up new rules, it creates a more stable and fairer environment for health insurance companies, patients and drug manufacturers.