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Pharmaceutical pricing in Turkey is conducted since 2004 with reference pricing system. According to the system, the prices of the pharmaceuticals are determined based on the lowest price of the five countries selected by the Ministry of Health (France, Spain, Italy, Portugal and Greece) and additionally the country from which the product is imported and the country where the “batch is released.”

A fixed Euro rate announced by the Price Evaluation Commission is utilized each year to convert the Euro prices to Turkish Lira instead of the actual Euro rate in these countries. This fixed rate is determined based on related legislation of the Ministry of Health. According to the legislation on the pricing of pharmaceutical products, the annual fixed exchange rate is computed based on a certain ratio (multiplier) of the annual average Euro exchange rate of the previous year. 70% was the multiplier valid until 2018, that was updated as 60% in 2019. The value of 1 Euro for 2019 should have been 3.9710 Turkish Liras with the old multiplier, but the change in legislation introduced right before the validity of the new rate, put it at 3.4037 Turkish Liras. With this move, the real FX rate of Euro approached twice the value of the fixed pharmaceuticals exchange rate. For 2020, the fixed Euro exchange rate was announced as 3.8155 TL to 1 Euro.

At the reimbursement stage, Social Security Institution additionally requires public institution discounts in addition to already low prices. Compared to Greece, which currently applies the lowest prices in Europe, the reimbursement prices in Turkey can be as low as a quarter of prices in Greece because of fixed rate and compulsory public institution discounts. These pricing policies are making the availability of innovative medicines to the patients and the sustainability of existing pharmaceuticals currently available in the market harder to achieve.

Despite the fact that global budget practice has ended in 2012, the fixed Euro rate used in pricing has stayed the same until 2015. After the change in legislation in 2015 the method of calculating the periodic Euro rates has changed; for pharmaceuticals price calculations a fixed Euro rate, calculated as a certain ratio of the mean of the previous Euro FX rate, was announced for the year at the beginning of each year. While 2016 and 2017 changes in Euro rate were reflected to the fixed pharmaceutical FX rate, in 2018 the adjustment was made as 15% instead of the calculated 23%. Moreover, the 70% fixed Euro ratio has been decreased to 60% in 2019. These changes, introduced days before annual rate updates timeframe, caused unpredictability. In 2020 the fixed pharma exchange rate was updated in line with the legislation.

According to a 2018 report commissioned to IQVIA by AIFD, out of every five molecules newly introduced and available for patient access in the world only one was registered and reimbursed in Turkey. To solve this issue of accessibility to innovation, innovative medicines unavailable in the Turkish market are imported and provided to patients upon their formal application since 2007, initially by the Turkish Pharmacists’ Association and later by İbn-i Sina Health and Social Security Centre and International Health Services, Inc. (İbn-i Sina Sağlık Sosyal Güvenlik Merkezi ve Uluslararası Sağlık Hizmetleri A.Ş.). Such pharmaceuticals are reimbursed after inclusion to the “list of medicines procured from abroad” by SSI with the authorization of the Ministry of Health. Products procured within this list have an increasing share of the total public pharmaceutical expenses.