The CANAMED reference price: what it is, how it's calculated, why it differs across pharmacies

CANAMED — the National Catalogue of Medicines (Catalogul Naţional al Medicamentelor) — is the basis for the maximum approved prices in Romania for all prescription (Rx) medicines. Here is what it is, who manages it, how the reference price used for CNAS (the National Health Insurance House) reimbursement is calculated, and why you see different prices across pharmacies.

What CANAMED is

CANAMED is managed by the Ministry of Health, with technical support from ANMDMR (the Romanian National Agency for Medicines and Medical Devices) and CNAS. It is a public database, updated monthly, that contains:

• the CIM code of each authorised medicine;
• the INN (active substance), commercial name, manufacturer;
• the pharmaceutical form, strength, pack size;
• the manufacturer price (PP — preţul producătorului);
• the maximum retail price (PVA — preţ vânzare amănuntul maximal, the maximum retail selling price);
• the reference price per INN (the cheapest generic, used to calculate reimbursement);
• the reimbursement sublist (A, B, C1, C2, C3, D);
• the status: active / inactive / discontinued.

The updated list can be downloaded from ms.ro and cnas.ro — public XLS / CSV files. On HartaFarmacii we integrate this catalogue to display reference prices alongside the real prices scraped from pharmacies.

How the manufacturer price is calculated

Under Emergency Ordinance (OUG) 12/2014 and Ministry of Health Order 368/2017, the manufacturer price for an Rx medicine in Romania is set through referencing to a country basket: the lowest price across 12 EU countries (Bulgaria, the Czech Republic, Slovakia, Poland, Hungary, Lithuania, Latvia, Estonia, Slovenia, Italy, Spain, Greece). The manufacturer declares the prices in those countries, and the Ministry of Health picks the lowest one — the PP in Romania is approved at that value.

The system has been consistently criticised because Romania picks “the lowest EU price”, which makes the Romanian market unattractive for manufacturers — many new medicines are introduced with a 2-3 year delay. But it is the explicit policy to keep prices low for patients and for CNAS.

Commercial mark-ups — distributor + pharmacy

On top of the manufacturer price, the system approves two regulated mark-ups (Ministry of Health Order 368/2017):

• Distributor mark-up — 10% up to a PP of 30 RON, dropping gradually to 8%, 6%, 4% for higher thresholds, down to 2% for a PP above 1000 RON.
• Pharmacy mark-up — 24% up to a PP of 30 RON, dropping to 18%, 14%, 12% etc. — down to a minimum of 4% on very expensive medicines.

Thus, the maximum PVA (retail selling price) = PP × (1 + distributor mark-up + pharmacy mark-up). The pharmacy may sell at the PVA or below the PVA — never above it. That is where competition between chains appears: Catena, Dona, Tei, Help Net, Dr.Max can cut their own mark-up to attract customers.

The reference price — exactly what it is and how it's used

For a given INN (e.g. atorvastatin 20 mg, 30 tablets), CANAMED lists all manufacturers (the Pfizer originator + 8-12 generics). Each has a maximum PVA. CNAS picks the lowest price among all of them as the reference price.

When a reimbursed prescription is dispensed:

• reimbursement is calculated on the reference price, not on the price of the chosen product;
• if the patient takes a product equal to or below the reference price, they pay only the difference between the reference price and the reimbursement (e.g. 10% for sublist A);
• if they choose a product above the reference price (an expensive originator), they pay the full difference above the reference price + 10%.

Why you see different prices across pharmacies

Three mechanisms:

1. Maximum PVA vs real price. The pharmacy may sell below the PVA. Large chains with volume (Catena, Dona) often have prices 2-5% below the PVA, especially on OTC products and during promotions.
2. Different product in stock. Atorvastatin 20 mg may be from Terapia (the cheapest), Krka (mid-range), or Pfizer (the most expensive). Pharmacy A has Terapia in stock, pharmacy B has Krka. The prices naturally differ.
3. OTC has no PVA — free pricing. For OTC products (paracetamol, ibuprofen), there is no maximum price. Competition is complete, so differences of 30-50% between chains are normal. On HartaFarmacii you see prices updated weekly by our own scrapers on the websites of the 4-5 large chains.

How to check your own reference price

1. Go to cnas.ro → the “Furnizori” (Providers) section → “Medicamente” (Medicines) → “Liste compensate” (Reimbursed lists) → download the current XLS.
2. Search by INN or commercial name.
3. Look at the columns: PP, PVA, Reference Price, Sublist, Reimbursement Percentage.
4. Calculate: (Reference Price × Reimbursement Percentage) = what CNAS covers; the rest is what you pay (plus any pharmacy difference above the reference price).

Or, more simply, on HartaFarmacii the product page shows the reference price alongside the prices of the scraped pharmacies.

The history of CANAMED — why it has changed several times

The CANAMED system was officially introduced through Emergency Ordinance (OUG) 152/2002 and massively reformed through OUG 12/2014. The successive reforms responded to three structural problems:

1. Prices too high in 2010-2013 — referencing was done against 12 EU countries but using the arithmetic average, not the lowest. Manufacturers offered “average” prices and CNAS paid above market. OUG 12/2014 switched to “the lowest EU price” — savings of 25-30% on the pharmaceutical budget.
2. Shortages after 2014 — manufacturers partially withdrew, leaving the Romanian market. From 2017, the Ministry of Health introduced a 60-day notification mechanism (Order 269/2017) and MED-ESS lists for essential medicines.
3. Rising costs for new therapies — oncology drugs, biotechnologies, gene/cell therapies. CANAMED could not accommodate catalogue prices — the solution: cost-volume-outcome contracts, separate from public CANAMED.

In 2025-2026, there are discussions in Parliament about a new reform (transparency of cost-volume contracts, including biosimilars in the reference price calculation, a more dynamic update mechanism). Changes are expected through Government Decisions during the year.

The role of wholesale distributors

Between the manufacturer and the pharmacy there is an ANMDMR-authorised wholesale distributor. There are a few large ones in Romania (Mediplus, Polisano, Farmexim, Farmexpert, Polifarma, Farma Direct, A&D Pharma — which partially merged with Dr.Max), plus a few specialised in oncology (Sanofi distribution, Pharma Direct Oncology).

The distributor mark-up — regulated in CANAMED — ranges from 2-10% depending on the manufacturer price. The distributor delivers to pharmacies on short lead times (24-48h for large chains, 3-5 days for independents). They keep their own reserve stocks for medicines with high demand. The distributors’ risks — supply disruptions from foreign manufacturers, exchange-rate fluctuations, customs delays — are the main cause of the temporary shortages in pharmacies that you can observe directly.

Price negotiation — the mechanism of annual Government Decisions

In addition to the automatic referencing against the EU country basket, the system provides for case-by-case negotiations between the Ministry of Health and manufacturers for expensive medicines (oncology, rare diseases, biotechnologies). These negotiations produce cost-volume contracts or cost-volume-outcome contracts, through which CNAS pays a lower price in exchange for a guaranteed volume or for measurable clinical results.

Common contract types:

• Simple cost-volume — a low price in exchange for the commitment that CNAS buys a minimum quantity. The manufacturer recoups through volume.
• Cost-volume-outcome — partial payment upfront, the rest after confirmation of the therapeutic effect (e.g. in oncology, for immunotherapies — full payment only for the patients who respond to treatment at 6 months).
• Risk-sharing agreement — the manufacturer partially reimburses for non-responding patients.

These mechanisms are not visible on public CANAMED — the listed prices are “catalogue” prices for the private market. For the patient, what matters is that access to expensive medicines in the national programmes (sublist C2) is free or with a minimal contribution, thanks to these behind-the-scenes negotiations.

Why it matters to you

By understanding CANAMED, you avoid two traps:

• Believing that “my pharmacy is the cheapest” because you have seen a single price. Check 2-3 pharmacies — differences of 20-40% are frequent.
• Believing that “a reimbursed prescription covers everything”. In fact, the pharmacy may sell above the reference price and you pay that difference in full, on top of your sublist contribution.

Checking CANAMED + comparing prices on HartaFarmacii can bring savings of 100-300 RON/month for a chronic patient with 4-5 medicines.