EXPONENTIAL GROWTH AND MARKET CONCENTRATION OF PUBLIC REIMBURSEMENT FOR INNOVATIVE CARDIOMETABOLIC PHARMACOTHERAPY IN HUNGARY, 2020-2025
Author(s)
Dalma Pónusz-Kovács, MSc1, Luca Fanni Kajos, MSc, PhD2, Tímea Csákvári, MSc, PhD3, Róbert Pónusz, MSc, PhD2, Bettina Kovács, MSc1, Ákos Várnagy, MD, PhD4, József Bódis, MD, PhD4, Imre Boncz, MSc, PhD, MD2.
1Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 2Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 3Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Zalaegerszeg, Hungary, 4Department of Obstetrics and Gynecology, University of Pécs, Pécs, Hungary.
1Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary, 2Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Pécs, Hungary, 3Institute for Health Insurance, University of Pécs, Faculty of Health Sciences, Zalaegerszeg, Hungary, 4Department of Obstetrics and Gynecology, University of Pécs, Pécs, Hungary.
OBJECTIVES: Pharmaceutical spending on innovative cardiometabolic and weight-management agents has accelerated worldwide, raising payer sustainability questions. The study aims to quantify the magnitude, growth pattern and market concentration of public reimbursement by NHIFA (National Health Insurance Fund Administration) for a defined cohort of community-pharmacy medications in Hungary, 2020-2025.
METHODS: The data were retrieved from the NHIFA for 31 reimbursed presentations covering 9 active substances across 4 classes: GLP-1 receptor agonists (liraglutide, dulaglutide, semaglutide-sc, semaglutide-oral), SGLT-2 inhibitors (dapagliflozin, empagliflozin, ertugliflozin), biguanide (metformin) and topiramate. Records were aggregated to annual NHIFA contribution and converted to EUR and USD at Hungarian National Bank aligned annual mid-rates. Exponential trend was tested with log-linear regression and CAGR; concentration with HHI, CR3 and Gini at active-substance level; between-class growth differences with Kruskal-Wallis.
RESULTS: Total NHIFA reimbursement 2020-2025 reached 341,649,608 EUR/377,628,480 USD, rising from 32,005,089/36,498,691 (2020) to 85,924,161/96,816,436 (2025), a 2.68× (EUR)/2.65× (USD) rise (EUR CAGR = 21.84%; USD CAGR = 21.54%; log-linear slope=0.203, R²=0.984, p<0.001). Spending was strongly concentrated at the substance level (HHI=0.207, CR3=66.91% [semaglutide-sc, semaglutide-oral, empagliflozin], Gini=0.489). Class shares (EUR/USD): GLP-1 RA 67.94% (232,045,621/256,249,763), SGLT-2i 27.97% (95,355,222/105,523,613), biguanide 2.78% (9,684,155/10,777,481), topiramate 1.31% (4,564,610/5,077,624). Semaglutide-sc alone carried 34.38% (117,915,303 / 130,370,251). EUR CAGRs diverged across classes (Kruskal-Wallis p<0.001): SGLT-2i +24.77%, GLP-1 RA +22.81%, biguanide -5.31%, topiramate -5.27%.
CONCLUSIONS: Hungarian public reimbursement for the studied cohort grew exponentially in 2020-2025 in hard-currency terms, driven almost entirely by GLP-1 RA and SGLT-2i agents, with semaglutide products carrying over one-third of the burden. The pronounced concentration and double-digit annual growth raise sustainability and HTA-prioritization questions for upcoming budget cycles.
METHODS: The data were retrieved from the NHIFA for 31 reimbursed presentations covering 9 active substances across 4 classes: GLP-1 receptor agonists (liraglutide, dulaglutide, semaglutide-sc, semaglutide-oral), SGLT-2 inhibitors (dapagliflozin, empagliflozin, ertugliflozin), biguanide (metformin) and topiramate. Records were aggregated to annual NHIFA contribution and converted to EUR and USD at Hungarian National Bank aligned annual mid-rates. Exponential trend was tested with log-linear regression and CAGR; concentration with HHI, CR3 and Gini at active-substance level; between-class growth differences with Kruskal-Wallis.
RESULTS: Total NHIFA reimbursement 2020-2025 reached 341,649,608 EUR/377,628,480 USD, rising from 32,005,089/36,498,691 (2020) to 85,924,161/96,816,436 (2025), a 2.68× (EUR)/2.65× (USD) rise (EUR CAGR = 21.84%; USD CAGR = 21.54%; log-linear slope=0.203, R²=0.984, p<0.001). Spending was strongly concentrated at the substance level (HHI=0.207, CR3=66.91% [semaglutide-sc, semaglutide-oral, empagliflozin], Gini=0.489). Class shares (EUR/USD): GLP-1 RA 67.94% (232,045,621/256,249,763), SGLT-2i 27.97% (95,355,222/105,523,613), biguanide 2.78% (9,684,155/10,777,481), topiramate 1.31% (4,564,610/5,077,624). Semaglutide-sc alone carried 34.38% (117,915,303 / 130,370,251). EUR CAGRs diverged across classes (Kruskal-Wallis p<0.001): SGLT-2i +24.77%, GLP-1 RA +22.81%, biguanide -5.31%, topiramate -5.27%.
CONCLUSIONS: Hungarian public reimbursement for the studied cohort grew exponentially in 2020-2025 in hard-currency terms, driven almost entirely by GLP-1 RA and SGLT-2i agents, with semaglutide products carrying over one-third of the burden. The pronounced concentration and double-digit annual growth raise sustainability and HTA-prioritization questions for upcoming budget cycles.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR2
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Pricing Policy & Schemes, Reimbursement & Access Policy
Disease
Diabetes/Endocrine/Metabolic Disorders (including obesity)