What is CANAMED and how does it affect medicine prices?

CANAMED — the National Catalogue of Maximum Prices for Medicines — is one of the most important regulators in Romanian pharmacy, yet almost nobody understands exactly how it works. Here is the simple explanation, with concrete examples of how it affects your wallet.

Corrected on 9 November 2026: the reimbursement percentages per sublist and the VAT rate.

What CANAMED actually is

CANAMED is an official document published and periodically updated by the Ministry of Health, through the National Agency for Medicines and Medical Devices (ANM). It contains the maximum prices for all medicines sold in Romania — that is, the highest price at which a medicine can legally be sold in any pharmacy.

The document contains three types of price for each medicine:

• The manufacturer price — what the company that makes the medicine receives.
• The distributor price — manufacturer + distributor mark-up (wholesale warehouse).
• The maximum retail price — distributor + pharmacy mark-up + VAT, the final price to the patient.

The pharmacy may sell at a lower price — not below cost, but below the CANAMED maximum price. It may not sell at a higher price.

Which medicines does CANAMED apply to?

CANAMED applies only to prescription-only medicines (Rx) — those for which you need a medical prescription. Examples:

• Antibiotics (amoxicillin, azithromycin, ciprofloxacin)
• Antihypertensives (ramipril, bisoprolol, amlodipine)
• Antidiabetics (metformin, gliclazide, insulin)
• Anticoagulants (acenocoumarol, apixaban)
• Antidepressants, anxiolytics (sertraline, alprazolam)
• Medication for chronic respiratory diseases (salbutamol, budesonide)

OTC (over-the-counter) medicines are not included in CANAMED — paracetamol, ibuprofen, vitamins, supplements, cough syrups. For OTC medicines the price is fully deregulated, which is why you see large differences between chains. Read our guide on how to find the best price.

How is the maximum price set?

ANM calculates the price according to a clear methodology, set out in Order 368/2017 and its later updates. The main elements:

1. The international reference. For each medicine, ANM compares the price proposed by the manufacturer with the prices in 12 reference countries (Bulgaria, Hungary, the Czech Republic, Poland, Slovakia, etc.) and chooses the lowest.
2. The CIP check (Comisia de Împrumut a Prețurilor) — validates the price and approves the listing.
3. The maximum pharmacy mark-up — regulated on a sliding scale: 35% for medicines under 50 RON, 24% for those between 50-300 RON, 12% for over 300 RON.
4. VAT of 11% (the reduced rate for medicines since 1 August 2025; 9% before that) — applied to the value including the mark-up.

The end result is the maximum retail price in CANAMED, which you will find published on the ANM website and in physical pharmacies (they are required to display it).

CNAS reimbursement — 20%, 50%, 90%, 100%

CANAMED works together with the reimbursement system of the National Health Insurance House (CNAS). For certain diseases and categories of patients, CNAS covers part or all of the price of the medicine:

• 90% reimbursement — Sublist A: the state pays 90% and the patient 10% of the reference price (for example enalapril, indapamide, sertraline).
• 50% reimbursement — Sublist B (for example atorvastatin, rosuvastatin, perindopril); pensioners with incomes below the threshold set by CNAS get 90%.
• 100% reimbursement — Sublists C1 (the chronic diseases on the list, with a diagnosis made by a specialist), C2 (the national health programmes: oncology, diabetes, rare diseases, etc.) and C3 (children, pregnant women, women who have recently given birth).
• 20% reimbursement — Sublist D; for children, pupils and students, and pregnant women the percentage is 100%.

The examples come from the CNAS nomenclature (SIUI) in force from 1 November 2026. The classification is made per pack, not per disease: the same INN can have products on different sublists. The percentage applies to the reference price, not to the selling price: if the product you choose costs more than the reference, you pay the difference in full.

A practical example

You have a prescription for a long-term medicine on sublist A (90% reimbursement):

• The pharmacy's shelf price: 45 RON
• The reference price for that INN and that strength: 40 RON
• 90% reimbursement of 40 = 36 RON (paid by CNAS)
• You pay: 45 − 36 = 9 RON

If you go to a pharmacy that sells at the reference price (40 RON), you pay 4 RON — 5 RON less. Over 12 months of long-term treatment, the difference reaches 60 RON on this single medicine.

How do you check a medicine's CANAMED price?

You have three official sources:

1. The ANM website — the “CANAMED” section, where you can download the updated document in XLS format.
2. The CNAS website (for the reimbursement list and percentages).
3. The pharmacy itself — by law, the CANAMED price must be displayed when the medicine is dispensed.

For a quick guide to the real prices charged by the big chains for OTC medicines (which are NOT in CANAMED), use our search.

The key difference: Rx vs OTC

Remember the simple rule:

• Rx (prescription-only) → price capped by CANAMED, small differences between chains (under 5-10%).
• OTC (without a prescription) → deregulated price, large differences between chains (up to 40-50%).

For Rx medicines your strategy is to look for the pharmacy with the lower mark-up and good reimbursement. For OTC medicines, it pays to compare actively on HartaFarmacii — that is where the savings are biggest.

Conclusion

CANAMED is a legal mechanism that protects you from abusive prices for prescription-only medicines. It does not guarantee you the best price, but it guarantees a cap. To pay as little as possible: always ask for the reimbursed prescription, look for the pharmacy that sells below the maximum price and ask for generics when they exist.

For OTC medicines, where CANAMED does not apply, HartaFarmacii is your main tool — there the differences between chains reach 30-50%.

Written by Andrei-Șerban Stoian, founder of HartaFarmacii — software engineer, not a doctor or pharmacist·Updated 2026-01-22