Oral antibiotics billed per unit starting January 1, 2027

Antibiotics in “solid-oral” pharmaceutical form whose ATC code begins with J01 will be billed per unit, and no longer per pack, when dispensed in a pharmacy open to the public. The Royal Decree of October 18, 2026, signed by King Philippe, is published in the Belgian Official Gazette (Moniteur belge) No. 254 of November 6, 2026, page 59577, under reference C − 2026/007982. It amends six existing royal decrees to adapt the patients’ personal contribution, the pricing data transmitted to the health insurance funds and the INAMI, as well as the pharmaceutical fee regime.

A regime based on key letter P

The text inserts an entirely new Chapter III into the Royal Decree of March 16, 2010, consisting of Articles 7/4 to 7/7. Its scope is precisely delimited: the dispensing, in a pharmacy open to the public, to a beneficiary who does not reside in a nursing and care home or a retirement home, of a reimbursable pharmaceutical specialty in “solid-oral” form whose ATC code begins with J01 and which is not listed in Article 19/1 of the Royal Decree of January 21, 2009, providing instructions for pharmacists.

The basic fee is calculated as the product of the value of key letter P, as established in the national agreement between pharmacists and insurance organizations, and the coefficient assigned to this key letter. Chapters I and II no longer apply to the cases covered by this new Chapter III; Chapter I, renamed, remains reserved for dispensing “per pack.”

Two specific fees with a coefficient of 2.28

The mechanism creates two distinct fees, both due per patient and per prescription:

• a fee referred to in Article 35octies, § 2, paragraph 2, of the Law of July 14, 1994, for the dispensing of reimbursable pharmaceutical specialties;
• a fee referred to in Article 35octies, § 2, paragraph 5, of the same law, in the event of repackaging during dispensing.

For each of these two fees, the coefficient is set at 2.28. Furthermore, the text adapts Article 126, § 1, of the Royal Decree of February 1, 2018: prescribing by international non-proprietary name remains possible, but specialties of the ATC J01 class are explicitly excluded from this rule. The pharmacist may dispense a specialty belonging to a packaging group of 28-30, 31-60, 61-90, or 91-120 units.

Amounts to four decimal places

Unit pricing imposes a new level of precision. Article 121, paragraph 2, of the royal decree of February 1st, 2018, now provides that the amounts for the unit dispensing of “oral-solid” specialties in pharmacies open to the public are indicated with four decimal places, and rounded to the nearest euro cent; if the result falls exactly on half a unit, it is rounded down.

Articles 9 and 10 of the same decree are also rewritten: the insurance intervention is determined, depending on the case, by an amount fixed per package or by an amount fixed per pharmaceutical unit appearing in the “Reimbursement Base” column, calculated in accordance with Annex V. Pricing offices and insurance organizations must transmit a new indicator, the “number of dispensing units,” as defined in Article 128 of the royal decree of February 1st, 2018.

Nursing home residents remain under package pricing

Article 1 amends the royal decree of May 7th, 1991, fixing the personal contribution of beneficiaries. Point A now targets specialties with a form other than “oral-solid,” or an “oral-solid” form whose ATC code does not start with J01, dispensed to a beneficiary not residing in a nursing home. Point B maintains “oral-solid” forms dispensed to a beneficiary residing in a nursing and care home or a nursing home for the elderly under the package regime.

The procedure was informed by several opinions: Healthcare Insurance Committee on May 11, 2026, Finance Inspector on July 6, 2026, agreement of the Minister of Budget on July 17, 2026, Commission for agreements between pharmacists and insurance organizations on April 2, 2026, and Budgetary Control Commission on May 6, 2026. Referred on July 31, 2026, under number 79.950/2/V, the Council of State waived issuing an opinion within the requested timeframe.

The decree enters into force on January 1st, 2027. In practical terms, pharmacies will have to account for units dispensed rather than boxes, while mutual insurance funds will settle interventions on this basis and patients will have their co-payment calculated per unit for these antibiotics. The Minister of Social Affairs, F. Vandenbroucke, is responsible for the execution of the text.

Source: Belgian Official Gazette (Moniteur belge) No. 254 of November 6, 2026, p. 59577, C − 2026/007982, royal decree of October 18, 2026, amending various provisions relating to the introduction of unit pricing for “oral-solid” antibiotics in pharmacies open to the public.