Latvia is buying access with manufacturers’ money. NVD credits most of this round to manufacturer participation and price negotiation, inside a reimbursement budget it already expects to overrun. For any company with a product in the 124-medicine queue, the entry ticket is a commercial offer.

• Spend per patient is what the budget office sees. Reimbursement spending rose 94% from 2018 to 2025, from €175.21 million to €339.48 million, while unique patients rose 6% to 760,047. Every new inclusion adds cost per patient, which is why each one is now negotiated against budget impact.
• Primary care initiation is the commercial lever in this round. From 1 October family doctors can start GLP-1 receptor agonists, direct oral anticoagulants and dementia treatment without a specialist visit, which NVD says will speed treatment starts. For those classes, field force targeting and volume forecasts should shift toward general practice now.
• The 2027 budget decides the queue. The health ministry has identified €130.3 million in additional need for reimbursed medicines within €663 million of total need, but has prioritised €319.5 million for 2027. Until funding moves, expect inclusion on stepwise criteria and price concessions, the route NVD describes for chronic migraine.