73.4% of Albanians' out-of-pocket health expenses go to medicines

Albania has about three private pharmacies for every 10,000 inhabitants, more than the average of 2.1 pharmacies in the United States, while the number of pharmaceutical personnel per capita is significantly above the European average. But the wide reach of the network has not been accompanied by a reduction in the financial burden for patients: the majority of medicines are still financed by families, and cheaper alternatives account for a very small percentage of the amounts reimbursed.

The World Bank report on the Albanian health sector notes that in 2023 the Mandatory Health Insurance Fund had contracts with 822 private pharmacies, 42 pharmaceutical agencies, 15 distributors and 43 drug importers.

In 2018, Albania had 10.9 pharmaceutical employees for every 10,000 inhabitants, compared to the European average of 6.7 employees. According to the World Bank, the size of the sector can create incentives for higher drug distribution and profit orientation, so more careful monitoring of pharmaceutical activity is required.

Public funding covers only a portion of the pharmaceutical market. 
In 2023, public funding covered only about 44% of the value of medicines imported into Albania, leaving the rest of the bill mainly borne by families.

The Fund's expenditures on reimbursable drugs increased from 12 billion lek in 2023 to about 13 billion lek in 2025. Of this amount, about 8 billion lek was used for outpatient drugs distributed through community pharmacies.

However, public spending on these drugs was only around 36 euros per capita in 2025, significantly lower than 97 euros in Bulgaria, 63 euros in Serbia, and 55 euros in Bosnia and Herzegovina. When including drugs used in hospitals, public pharmaceutical spending in Albania amounts to around 57 euros per capita.

The Albanian pharmaceutical market is estimated at around 339.1 million euros, or 143 euros per capita. The state finances around 40% of the market and public spending on medicines accounts for only 0.5% of Gross Domestic Product.

By comparison, public financing covers 68% of the market in Serbia, 57% in Bosnia and Herzegovina, 71% in North Macedonia and 69% in Montenegro. Public spending per capita amounts to 168 euros in Serbia, 87 euros in Bosnia and Herzegovina, 95 euros in North Macedonia and 256 euros in Montenegro.

Three-quarters of out-of-pocket payments go to medications

Data from the 2023 Household Budget Survey show that 73.4% of health expenses that citizens pay directly out of pocket go to medicines purchased at private pharmacies.

On average, families spend 26.3 lek per person per day on medicines. The insured spend an average of 27.4 lek, compared to 23 lek per person per day for the uninsured. The richest families reach 53.8 lek per person per day.

The World Bank notes that the difference is not only related to health needs. It is influenced by the structure of the reimbursement list, co-payments, prescribing practices by physicians, brand choice, and the use of reimbursable alternatives.

Cheaper alternatives are underused, while a few drugs take up the bulk of the bill

The list of reimbursable drugs has been expanded to 1,345 products, with reimbursement rates ranging from 50% to 100%, but reference-priced alternatives are used very little. In 2025, they typically accounted for less than 10% of the amounts reimbursed, and in some cases less than 1%, although they do not require co-payments for the brand difference. This shows that patients are often oriented towards more expensive drugs, paying a significant portion out of pocket; for some anti-diabetic drugs, co-payments can exceed 80% of the cost.

Spending is also concentrated on a few products: the 20 most expensive drugs in hospitals account for about a quarter of the hospital bill, while the 20 most expensive outpatient drugs account for over a third of the cost of products dispensed in pharmacies. The World Bank recommends strengthening reference prices, increasing the use of generics and biosimilars, and limiting reimbursement for significantly more expensive brands./ekofin.al