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03 December 2025 | Country Update
Creation of a National Procurement and Logistics Centre
5.6. Pharmaceutical care
Information on the regulation, reimbursement and distribution of pharmaceuticals can be found in sections 2.7.4 and 3.7.1.
In 2021, the SHI spending on drugs for outpatient treatments reached €268.5 million in Luxembourg (CNS, 2023d). Out of the total drug expenditure, 23.9% was allocated to outpatient hospital-dispensed drugs, which is a significant increase compared with 2.4% in 2012 (CNS, 2013). This upward trend can be attributed to the introduction of new and expensive drug treatments such as hepatitis C medications, immunotherapy, chemotherapy and others. In addition, Luxembourg ranks 39th in Europe regarding expenditure on pharmaceuticals as a proportion of total household expenditure on health. Pharmaceuticals and therapeutic appliances account for 38% of total household health care expenditure, which is slightly below the OECD average but higher than in neighbouring countries (see sections 3.4 and 7.3).
According to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net), Luxembourg’s antibiotic consumption is below the European average both in community and hospital settings. As observed in almost all European countries, antibiotic consumption significantly decreased in 2020 and 2021, especially in the community setting, then rebounded in 2022. This common trend may be linked to the effect of COVID-19 mitigation measures, with lockdowns and face masks contributing to a decrease in common bacterial infections that returned to normal once COVID-19-related measures were lifted (Högberg et al., 2021). The latest 2022 data show a total antibiotic consumption of 19.05 defined daily dose (DDD) per 1000 inhabitants per day in Luxembourg, mostly consumed in the community sector (primary care) (17.64 DDD), including 7.65% quinolones and 11.22% cephalosporins (ECDC, 2023). The hospital sector accounts for very little of the overall antibiotic consumption (1.41 DDD per 1000 inhabitants per day), but uses a high share of quinolones (9.21%) and cephalosporins (24.82%).
Antibiotic consumption and antimicrobial resistance concerns have been on the political agenda for several years. Efforts include communication campaigns conducted to raise awareness and educate patients, animal keepers, physicians and veterinarians about antibiotic misuse and its associated risks (OECD/European Observatory on Health Systems and Policies, 2023). Additionally, the National Antibiotic Plan launched in 2018 (subsequently revised and extended until 2024) forms a crucial component tackling the broader “One Health” strategy by integrating various sectors to develop and enforce programmes, policies, laws and research initiatives with the common goal of enhancing public health outcomes.
Much like its European counterparts, Luxembourg faced an increase in medicine shortages in 2022. Already in 2021, there were notable shortages in vaccine availability, including the DTP,[8] hepatitis B and Hib[9] vaccines, all experiencing stock unavailability for up to five months (CHD, 2022c). Since spring 2022, paediatric doses of paracetamol-based medicines are also subject to availability problems.
Luxembourg records high consumption rates of medicines for benzodiazepines and related drugs, which are the most commonly prescribed sleeping pills and tranquillizers (2020). A study by Cloos et al. showed that almost one-sixth of the adult insured population took at least one benzodiazepine annually, with half of them being intermediate users[10] and almost one-fifth being continuous users[11] (Cloos et al., 2015). Despite benzodiazepine not being recommended for older adults, these rates are even higher when looking at the population aged 65 years and over, with chronic benzodiazepine users representing 52.8 per 1000 people, much higher than in Denmark (10.9), the Netherlands (16.8), or the OECD average (17.7) (OECD, 2021). To address this public health concern, the National Centre for Addiction Prevention operates a helpline to assist individuals seeking advice and support, particularly those dealing with dependency issues, and to provide informative flyers on benzodiazepines. Similarly, Luxembourg has the highest rates of polypharmacy in people aged 65 years and older when compared with a selection of 16 countries, and over 80% of the Luxembourgish population aged 75 years and above take more than five medications concurrently, further highlighting the prevalence of polypharmacy (OECD, 2021).
The use of generics to improve access to medicines is limited in Luxembourg. In 2014, Luxembourg introduced a generic substitution scheme. Not mandatory, this substitution scheme was assigned to two pharmacotherapeutic groups for substitution with the cheapest generic option, regardless of the doctor’s prescription. Pharmacists are obliged to inform patients about available generic substitutes. There are no financial incentives for pharmacists or physicians, but the extra costs for choosing non-generic medication are borne by the patient, as the cost-sharing rate is calculated based on the price of the generic (CSS, 2024). Despite this generic substitution scheme, Luxembourg has the lowest volume and value of generic use in outpatient treatments in the EU, accounting for only 5.6% of the outpatient pharmaceutical market covered by health insurance (OECD/European Observatory on Health Systems and Policies, 2023) (see sections 3.7.1 and 7.6).
Pharmaceuticals are distributed through community and hospital pharmacies (see sections 4.2.2 and 2.7.4). Community pharmacies are managed via State concession or privately (see section 2.7.4). Besides medications, community pharmacies offer therapeutic products, medical devices, nutritional supplements, cosmetics, and hygiene items.
No studies or national reports about waste in pharmaceutical spending is available.
A law adopted on 3 December 2025 establishes the National Procurement and Logistics Centre (Centrale nationale d'achat et de logistique, CNAL) which will centralize and coordinate purchasing and logistics of medical products for many inpatient and outpatient providers. It operates under the supervision of the Minister of Health and is funded through an annual allocation and contribution from the state budget.
The new centre aims to enhance organizational efficiency, reduce administrative workload for health and pharmaceutical staff, generate budget savings, and optimize storage capacities. Centralizing procurement is also intended to strengthen the national health system’s responsiveness and improve availability of essential medical supplies.
The centre’s responsibilities include:
- operating as an external hospital pharmacy under the supervision of a responsible pharmacist;
- procuring, storing and distributing medical and sanitary products, medicines and related supplies;
- establishing, managing and maintaining the national critical and strategic stock, including vaccines and personal protective equipment; and
- procurement and distribution of medicines for the national immunization programme.