Ukraine expands medical outpatient reimbursement in 2026 and introduces 50% co-payment for selected therapies

On 31 December 2025, the Cabinet of Ministers of Ukraine adopted Resolution No. 1808 On Certain Issues of Implementation of the Programme of State Guarantees of Medical Care for the Population in 2026, which approves an updated list of medicines subject to outpatient reimbursement under the Affordable Medicines programme, among other regulations defining tariffs for health-care services and the reimbursement of medicines. 

Introduction of higher co-payment for selected therapies

For the first time since the Affordable Medicines programme began in 2017, the government has included several therapies where reimbursement will cover only 50% of the regulated retail price, with the remaining 50% payable out-of-pocket. Historically, co-payments under the programme have generally not exceeded 10%.

While the higher co-payment level may appear restrictive, it increases affordability since this change introduces partial public funding for mostly innovative therapies that were previously paid entirely out-of-pocket.

The affected pharmaceutical therapies include:

• Dapagliflozin (Forxiga);
• Empagliflozin (Jardiance);
• Apixaban (Eliquis and others) – the only multi-source medicine in this group;
• Dabigatran etexilate (Pradaxa);
• Rivaroxaban (Xarelto).

These therapies are used primarily in the treatment of cardiovascular diseases and diabetes. All have undergone a health technology assessment (HTA) in Ukraine and received positive HTA results, although for some products inclusion in the reimbursement list occurred several years after the HTA recommendation.

Additional reimbursed therapies

Ukraine has also expanded reimbursement to include:

• Formoterol + Beclometasone (Foster) for chronic lower respiratory diseases; and
• Atorvastatin, added to the cardiovascular therapies list.

These medicines will be reimbursed under the general rules of the Affordable Medicines programme (i.e. without co-payment or with a limited co-payment, expected to be 10%), in line with the existing outpatient reimbursement framework.

Timing and conditions of reimbursement

Unlike most outpatient medicines already covered by the programme, the above listed therapies will be reimbursed beginning 1 April 2026, rather than from the beginning of the year.

Reimbursement by the National Health Service of Ukraine will be provided following the marketing authorisation holders (MAHs) application for reimbursement and the inclusion of the relevant medicines in the Ministry of Health–approved reimbursement list.

Reimbursement mechanics and regulatory outlook

For therapies reimbursed under the general rules, no material changes are expected to be made to the existing reimbursement process or pricing mechanics.

For medicines reimbursable from 1 April 2026, however, and in particular for those subject to the 50% reimbursement cap, there is expected to be a new or modified approach to reference pricing and calculation of reimbursable prices. At present, the details of this approach have not yet been formally regulated.

It also remains unclear why Formoterol + Beclometasone, unlike other single-source therapies added to the reimbursement list following a positive HTA assessment, was not included among the medicines subject to the 50% reimbursement limit. 

Market practice suggests that MAHs and Ukraine’s Ministry of Health engaged in individual discussions regarding inclusion of additional innovative products in the reimbursement list. While these discussions facilitated access for several therapies, it should be noted that no formalised or transparent negotiation procedure currently exists, unlike the established frameworks applicable to managed-entry agreements and public procurement of innovative therapies.

For more information on this Resolution and Ukraine’s health-care sector, contact your CMS client partner or the CMS expert: Borys Danevych.