Romania sued over pharmacy arrears

A pharmacy that hands out state-reimbursed medicines does not get to delay its own bills. The wholesaler still wants payment. Staff still need wages. Rent still falls due. When the state pays late, the pharmacy carries the gap itself, either by borrowing, stretching suppliers, or keeping less stock on the shelves.

That is the mechanism behind the European Commission's case against Romania at the Court of Justice of the EU, the bloc's highest court. CNAS, the Romanian public body that reimburses pharmacies for medicines dispensed under the state system, is accused of paying so late, and so repeatedly, that it breached EU single-market law.

For Maltese readers, the issue is familiar in shape even if the sector is Romanian. Brussels is not telling a member state how to run its health service. It is saying that once the state relies on private operators to deliver a public service, it cannot use delayed payment as a quiet form of financing.

Three warnings, no fix

The Commission is using the Late Payment Directive, an EU law that sets strict deadlines for public authorities paying suppliers. Healthcare bodies are allowed up to 60 days, longer than most public payers, but the extra time is not a licence to keep pharmacies waiting indefinitely.

Romania was warned three times over two years. The Commission sent a formal notice in April 2024, then two reasoned opinions in February 2025 and January 2026. A reasoned opinion is Brussels' formal written demand to fix a breach before the case goes to court. Romania's answers did not satisfy the Commission, so the file has now moved to Luxembourg.

Romania's own submissions showed the scale of the delay. CNAS was still paying pharmacies an average of 62 to 79 days beyond the 60-day legal ceiling (Stiri pe surse). In practice, that means pharmacies were not just waiting two months for reimbursement. They were waiting roughly four months or more.

CNAS rejects the way the case is being presented. It says the dispute reflects an older situation, that arrears were cleared between October 2025 and April 2026, and that medicine payments were up to date on 8 July 2026 (Digi24).

That may help Bucharest politically, but it may not settle the legal point. An infringement case tests what a state did during a defined period. Repairs made after the case has reached its decisive stage can make the government look more responsive, but they do not automatically erase the breach.

What the Italian ruling tells Romania

The Court has already ruled on a very similar case. In Commission v Italy (C-122/18), it found that Italy had violated the Late Payment Directive because its public authorities were actually paying late.

Italy's defence did not work. The fact that it had written the directive into national law was not enough. Nor was it enough that unpaid suppliers could theoretically sue. The Court looked at the reality: did the state pay on time? It did not.

That precedent is a poor one for Romania. If the Commission proves that CNAS paid beyond the 60-day limit during the relevant period, Romania is likely to face the same finding. Italy eventually built a public-sector payment monitoring platform and improved enough for the Commission to close the case (IFEL).

Romania's "historical problem" defence will only become convincing if it produces the same kind of durable evidence: not a one-off clearance of arrears before judgment, but data showing CNAS can keep payments within 60 days as a normal operating rule.

Romania is not the only member state to treat late reimbursement as a budget tool. Poland's national health fund has proposed settlement cycles that would make hospitals treat patients first and wait months for payment, in effect lending the state their operating capital (Rzeczpospolita). In Hungary, delayed hospital payments have accumulated default interest through years of litigation (Portfolio).

Romania, however, is the first member state the Commission has taken to court over this practice. That matters because a judgment would turn a familiar administrative habit into an EU law warning for every government using suppliers as a cash cushion.

A narrow rule with real teeth

The EU does not run national healthcare systems. The treaties leave the organisation and financing of health services to member states (Article 168 TFEU). That boundary matters, including for small states such as Malta, where health policy is deeply domestic and politically immediate.

The Commission's case is narrower. When a state uses private pharmacies to deliver public healthcare, it must pay them within the deadline set by EU law. The Late Payment Directive exists to stop public authorities from using their size and leverage to shift hidden financing costs onto smaller suppliers.

That is the point Brussels is pressing. Using pharmacies as a cash buffer is not a sovereign choice about how to organise healthcare. It is a single-market breach, because it distorts the terms on which private businesses operate when dealing with the state.

If the Court rules against Romania and CNAS still does not comply, the Commission can return under Article 260 TFEU, the treaty route for asking the Court to impose daily financial penalties on a member state that ignores a judgment.

A ruling would also put pressure on other capitals with similar habits. Romania's case now turns less on whether the arrears can be called historical, and more on whether CNAS can prove that pharmacies will be paid on time as a matter of routine.