Why Medicines Cost Less in Türkiye — How Medicine Prices Are Set, Country by Country

How does Türkiye set the official price of a medicine?

Türkiye's pricing regime is set out in the Resmî Gazete as the "Beşeri Tıbbi Ürünlerin Fiyatlandırılmasına Dair Karar" (Decree No. 11031), published in Resmî Gazete No. 33194 on 12 March 2026 and effective the following day, 13 March 2026.

Under this decree the Ministry of Health designates a reference basket of at least five and at most ten EU member states. In practice the basket has historically included France, Italy, Spain, Portugal and Greece. For each product, the ex-factory price actually charged in every basket country is collected, and the single lowest of those prices becomes the source price used to calculate the Turkish ceiling.

That source price is quoted in euros, so it has to be converted into Turkish lira. This is where the second, decisive mechanism comes in: the exchange rate used for the conversion is not the market rate on the day of pricing.

What is the "pharmaceutical euro" and how has it changed over time?

Türkiye converts the euro-denominated source price using a specially defined rate called the "Dönemsel Avro Değeri" (the periodic, or fixed, pharmaceutical euro). It is calculated as the previous calendar year's average Turkish Central Bank euro selling rate, multiplied by an adaptation coefficient. The March 2026 decree raised that coefficient from 60% to 65%.

Because it is built from a past year's average and a fixed coefficient, the pharmaceutical euro deliberately does not track the spot euro/lira rate. It only changes when the Ministry revises it, which historically has happened a handful of times a year, and it can lag far behind the currency market during periods of rapid depreciation.

The rate currently in force is 26.8767 TL, applicable until 31 March 2026, after which 29.1164 TL takes effect from 1 April 2026.

What ceilings and discounts apply on top of the reference price?

Once the source price is converted, further ceilings apply depending on the product's status. Products facing generic competition are capped at 60% of the source price. Products that were price-protected because they were first marketed in Türkiye before 1 January 2000 are capped at 80%. A first-generic incentive allows a temporarily higher ceiling that steps down over three years, from 80% to 75% to 70%.

On top of these ceilings, a mandatory public-institution discount (kamu kurum iskontosu) is applied when a product is reimbursed by the state, typically in a range of roughly 28% to 41% depending on the product's category and price band. Structurally it is built from a base discount of 11%, plus an additional 17% or an additional 30% depending on the band the product falls into.

How do other countries decide what a medicine should cost?

External reference pricing — comparing a country's own price to prices already charged elsewhere — is the most common mechanism worldwide. By 2011, 24 of the then 27 EU member states used some form of it. Baskets vary enormously: France and the Netherlands historically referenced as few as four countries, while Spain's basket has run to 22 or more.

The calculation method also differs by country. Canada uses the median of seven reference countries; France takes the lowest price found in its basket, similar in spirit to Türkiye's approach; the Netherlands uses the average of its reference basket rather than the lowest or the median.

What is value-based pricing, and how do the UK and Germany use it?

Instead of, or alongside, comparing foreign prices, some regulators price a medicine according to the health benefit it delivers. The UK's National Institute for Health and Care Excellence (NICE) assesses cost per quality-adjusted life year (QALY). NICE announced on 1 December 2025 that its standard cost-per-QALY threshold range would rise from £20,000–£30,000 to £25,000–£35,000, effective from April 2026.

Germany's AMNOG framework works differently again: a manufacturer may set its own price freely for the first six months after launch. After that, a price negotiated with the statutory health insurers applies — and it is applied retroactively back to the start of month seven, not just going forward.

Why are medicine prices in the United States different from everywhere else?

The United States largely leaves drug pricing to negotiation between manufacturers, insurers and pharmacy-benefit managers rather than to a government reference mechanism. A RAND Corporation report, using 2022 data and published 1 February 2024, found that US prices across all drugs averaged 278% of prices in 33 other high-income comparison countries, rising to 422% for brand-name originator products at gross list prices. Even after accounting for confidential rebates, RAND described US net prices as still over three times as high.

The same RAND analysis contains an important counterpoint that is often left out of headlines: US prices for unbranded generic medicines are, on average, cheaper than in most of the comparison countries. The extreme US premium is concentrated in branded, patent-protected originator products, not across the whole market.

Why do published list prices overstate real differences between countries?

Almost every cross-country price comparison, including the ones summarised above, is built from published list prices — and list prices are known to overstate the real gap between markets. A study in Frontiers in Pharmacology, published 9 March 2026 and covering 23 hospitals across 9 European countries, found that actual negotiated hospital purchase prices were between 7% and 38% below the published reference prices for the same products.

The same study found that at least half of the participating hospitals misjudged how their own price compared with their peers' — believing they were paying more or less than they actually were. It also documented wide cross-country spread for individual products at list price: ribociclib's spread reached €3,961, a variation of 183%, and pomalidomide's reached €3,098, a variation of 45%. These are the study's findings about how much published prices can disperse across countries — they are not prices quoted for sale.

Does the EU's parallel-trade freedom apply to Türkiye?

Within the European Union, the free movement of goods under Article 34 of the Treaty on the Functioning of the European Union (TFEU) makes it lawful for a distributor to buy a medicine in one member state and resell it in another where the price is higher — so-called parallel trade. In 2019 this amounted to about €5.7 billion of parallel imports across the European Economic Area, with national penetration reaching 26.2% in Denmark, 12.0% in Sweden and 8.5% in Germany.

Türkiye is not a member of the EU or the EEA. It sits entirely outside this legal framework, so the TFEU's parallel-trade freedom simply does not extend to trade between Türkiye and EU/EEA member states. Türkiye's pricing and any cross-border medicine movement are governed by its own national rules, not by EU internal-market law.

How can I check a published price myself?

The most reliable approach is always to go to the official, government-published source for the country in question rather than relying on a third-party summary, including this one.

1. For Türkiye, check the official TİTCK price list.
2. For Qatar, check the Ministry of Public Health's drug pricing page.
3. For Kuwait, check the Ministry of Health's official site.
4. For Azerbaijan, check the Tariff Council (Tarif Şurası).
5. For the UAE, search the MOHAP registered-drugs list.
6. Always note the retrieval date, because official lists are revised regularly and a screenshot or quote can go out of date within weeks.

Frequently asked questions

Sources

• Resmî Gazete — Beşeri Tıbbi Ürünlerin Fiyatlandırılmasına Dair Karar, No. 11031 — retrieved: 2026-07-28
• TİTCK — İlaç Fiyat Listesi — retrieved: 2026-07-28
• Qatar Ministry of Public Health — Drug Prices — retrieved: 2026-07-28
• Kuwait Ministry of Health — retrieved: 2026-07-28
• Azerbaijan Tariff Council (Tarif Şurası) — retrieved: 2026-07-28
• UAE MOHAP — Registered Drugs Search — retrieved: 2026-07-28
• RAND Corporation — International Prescription Drug Price Comparisons — retrieved: 2026-07-28
• NICE — National Institute for Health and Care Excellence — retrieved: 2026-07-28
• Frontiers in Pharmacology — retrieved: 2026-07-28
• EUR-Lex — Treaty on the Functioning of the European Union (TFEU) — retrieved: 2026-07-28
• World Health Organization — retrieved: 2026-07-28

Related pages