The Greek Market
Overview
The Greek healthcare environment
Regulatory Bodies
EOF
National Organization for Medicines:
The National Organization for Medicines (EOF) was established in 1983, with Act 1316, and is a public entity of the Ministry of Health & Social Solidarity. The Agency’s Mission Statement was established by Presidential Decree 142 in 1989. The Presidential Decree defines the Agency’s legal framework, its function as the National Competent Authority, and its formal organizational structure.
EOF’s objective is to ensure public health and safety and is the competent Authority for the following products, marketed in Greece:
- Medicinal products for human and veterinary use.
- Biological products for human and veterinary use.
- Food Supplements and Food for Special Medical Purposes.
- Foods intended for particular nutritional uses (eg. for infants, young children) and Total Diet Replacements for weight control.
- Biocides.
- Medical devices.
- Cosmetics.
The responsibility for pricing of pharmaceuticals lies with the National Organisation for Medicines (EOF) that issues the official prices having the consent of the Minister of Health. The prices of pharmaceuticals are published in a Price Bulletin. A medicine cannot be marketed unless it has been granted a price.
MINISTRY OF HEALTH
• Pharmaceutical policies and regulations
• Reimbursement (HTA)
• Issuing of price bulletins
THE SOCIAL INSURANCE SYSTEM (EOPYY)
In the context of the challenging economic environment, one of the government’s measures to increase efficiency and contain health expenditure was the establishment of a Unified Healthcare Fund (EOPYY).
The National Organization for Healthcare Provision (EOPYY) constitutes the healthcare insurer and a main provider of PHC in Greece.
The organization started its operations on 1st January 2012. EOPYY’s primary mission is the provision of health services to active members, pensioners and their family dependents registered to the merging healthcare funds. EOPYY unified the majority of healthcare funds, amongst them being the Private Employees’ Fund (IKA), the Public Employees’ Fund (OPAD), the Farmers’ Fund (OGA) and the self-employed/Entrepreneurs’ Fund (OAEE).
As a result, EOPYY covers over the 98% of the insured population (close to 11 million).
Unified Social Security Fund (E.F.K.A.)
A new fund is established, the “Unified Social Security Fund” (E.F.K.A.). As of 1 January 2017, it has absorbed the existing main social security funds (i.e., I.K.A. – E.T.A.M., E.T.A.P. – M.M.E., E.T.A.A., O.A.E.E., etc.).
Following the provisions of article 1 of law 4670, the “Single Unified Social Security Fund (EFKA)” is renamed to “Electronic National Social Security Fund”, hereinafter referred to as “e –EFKA”. The renaming of EFKA marks the transition of the social security system to the digital age, transforming EFKA and upgrading its online services to citizens.
The integration of the social security database is promoted and the digitalization of all social security functions aims to ensuring more efficient and faster services to the citizens. The integration of the social security database will allow the digitalization of all the functions of social security and consequently its better management.
The organization and operation of e-EFKA is governed by the provisions of law 4387/2016 and Presidential Decree 8/2019 “Organization of the National Electronic Social Security Fund: e-EFKA” as in force.
Greek Health Environment
IOBE FACTS AND FIGURES
(data from 2024)
ECONOMIC ENVIRONMENT
The Greek economy grew by 2.3% in 2024, the same rate as in 2023, while a similar increase in economic activity is expected for 2025. At the fiscal level, a surplus was recorded in 2024, and financing conditions for the economy as a whole are improving. Demographic trends continue to influence healthcare and pharmaceutical expenditure, such as the negative natural balance (births minus deaths), which decreased by 57,000 in 2023. This leads to a gradual decline in the total population. Additionally, high life expectancy (81.9 years in 2024) and an ageing population — with an increase in the proportion of people aged over 65 and 80, rising from 23.3% to 33.1% and from 7.0% to 16.3% of the total population, respectively, by 2070 — point to deteriorating health and social security systems under increased pressure.
PHARMACEUTICAL EXPENDITURE
Total expenditure on pharmaceuticals and other medical non-durable goods accounted for €5.1 bil. in 2023, a decrease by 17.3% compared to 2009 in nominal terms. Similarly, public expenditure on pharmaceuticals and other medical non-durable goods fell from €4.8 bil. in 2009 to €2.6 bil. in 2023, marking an even sharper decrease of 44.7%. In contrast, private expenditure on pharmaceuticals and medical non-durable goods increased by 80.7% from €1.3 bil. in 2009 to €2.4 bil. in 2023.
Total pharmaceutical expenditure, both outpatient and inpatient, increased to €7.5 bil. in 2023, with estimates pointing to a further increase to €8.5 bil. in 2024, compared to €6.2 bil. in 2022. Public pharmaceutical expenditure is projected at €3.0 bil. in 2024, while the pharmaceutical industry’s contribution through mandatory returns is estimated to have exceeded €4.6 bil., compared to €3.9 bil. in 2023 and €2.9 bil. in 2022. Patient copayment also increased to €740 mil. in 2023 and is estimated to exceed €800 mil. in 2024.
Pharmaceutical expenditure has increasingly shifted toward industry funding. Between 2019 and 2024, industry contributions grew at an average annual rate of 20%, compared with 11% for total expenditure, while patient contributions rose by 5% and public spending by just 3.6%.
By 2023, the industry financed over 50% of total pharmaceutical expenditure, public funding fell to 36% (down from 84% in 2012), and patients accounted for 10%. In 2024, industry and patient contributions together made up 64% of total pharmaceutical spending.
PATIENT ACCESS TO INNOVATIVE THERAPIES
According to the latest study, published in May 2025, of the 173 innovative medicines that received central authorisation from the EMA between 2019 and 2023, 75 are available to Greek patients (43%), compared to an EU average of 43% (72 preparations).
Greece lags significantly behind other countries in terms of the time it takes for medicines approved by the European Medicines Agency (EMA) to be reimbursed by health systems. Specifically, according to the findings of the relevant study, the average reimbursement time in Greece is 654 days, which is 76 days longer than the European average of 587 days.
The most recent data confirm that delays in submitting reimbursement applications result from a multifactorial set of causes. The lack of funding for the reimbursement of new medicines is the most frequently cited cause in Greece and, more generally, in southern European countries, accounting for the highest relative percentage compared to other European regions.
According to the latest data1 from IQVIA, only one (1) in five (5) innovative medicines introduced in the last four years is available to Greek patients.
The number of new active substances approved by the European Medicines Agency (European Medicines Agency-EMA) in 2023 (39 new approvals) increased by 4.9% compared with 2022 (41 approvals).
PATIENTS’ CONTRIBUTION
Public pharmaceutical expenditure includes expenditure on prescription medicines, i.e. all medicines reimbursed by Social Security Funds (SSF). Net public pharmaceutical expenditure is the final amount reimbursed by SSFs after deduction of the mandatory rebates and clawbacks paid by pharmaceutical companies.
Private pharmaceutical expenditure consists of patient co-payments for reimbursed medicines, full out-of-pocket payments for non-covered or non-reimbursed medicines, and reimbursements provided by private insurance. Patient participation in reimbursed medicines includes statutory co-payments of 0%, 10%, or 25% of the reimbursement price, as well as additional charges when patients choose medicines priced above the reimbursement level. Other private payments cover non-prescription (OTC) medicines, prescription medicines excluded from reimbursement, and reimbursed medicines that patients choose to pay for entirely without using insurance.
THE PHARMACEUTICAL CHAIN IN GREECE
The pharmaceutical supply chain in Greece is a highly developed and dynamic sector, involving pharmaceutical companies (domestic manufacturers and multinational importers), wholesalers, and pharmacies. Most pharmaceutical products are distributed through the channel pharmaceutical companies → wholesalers → pharmacies, except for hospital medicines, which are supplied directly without wholesaler involvement.
Greece’s pharmaceutical market includes approximately 180 pharmaceutical companies, 350 Marketing Authorization Holders, 149 wholesalers and pharmacists’ cooperatives, 10,503 pharmacies, 265 hospital pharmacies, and 38 EOPYY pharmacies. Direct sales from pharmaceutical companies to pharmacies are permitted, and in specific cases medicines may be dispensed by doctors or delivered directly to patients following insurance fund approval.
The role of wholesalers is fulfilled by private pharmaceutical wholesalers and pharmacists’ cooperatives. Notably, Greece has the highest pharmacy density in the EU, with about 100 pharmacies per 100,000 inhabitants in 2022.
STRUCTURE OF THE PHARMACEUTICAL MARKET
Pharmaceutical products are classified according to their patent protection status. In Greece, based on data from IQVIA, the volume penetration of protected (on-patent) medicinal products represents 6.6% of the market, which is higher than the EU18 average (6.0%), as justified by the significantly lower prices of these products compared to EU18 countries (€1.11 per unit compared to €2.32).
The penetration in terms of volume of non-protected pharmaceutical products (off-patent & generics) amounts to 73.0% in total (32.8% and 40.2%, respectively). It is worth noting that the penetration in volume of off-patent products in Greece is higher than the EU18 average (19.4%), while for generics it is much lower than the EU18 average (60.5%).
Based on IQVIA data, the increased penetration in volume of unprotected medicines (off-patent & generics) is justified for off-patent medicines by their significantly lower prices compared to EU18 countries (€0.29 per unit compared to €0.46), while, correspondingly, the lag in the penetration of generics is justified by their relatively higher prices compared to EU18 countries (€0.19 per unit compared to €0.15).
The OTC market is on the rise from 2022 onwards, in terms of value, as it grew from €288 mil. to €356 mil. in 2025, marking an increase of 23.6%. The percentage of generics in value in 2023 stood at 34.2%, while in volume the percentage stood at 30.3%, showing a steady increase since 2012.