Belgium is known worldwide as the “Pharma Valley” of Europe, a position accompanied by heightened scrutiny by the Belgian Competition Authority (BCA). Since 2015, the BCA has considered the pharmaceutical sector an absolute top priority, focusing on three pillars: tackling cartel agreements, combating abuse of dominance and stricter control of mergers and acquisitions. Below, we analyze what competition law means for players in the healthcare and pharma sectors.
1. Horizontal agreements
The BCA takes strict action against collaborations that restrict competition, even when they appear legitimate at first glance.
Category Management under fire
One of the most notable recent cases is the case involving “Space Management” (SMAN). This involved manufacturers of over-the-counter (OTC) drugs working together to organize shelf space in pharmacies. The project created by 3 partners (Johnson & Johnson Consumer, Boehringer Ingelheim and Haleon) officially aimed to promote sales through a logical layout for consumers. However, the BCA ruled that the system was abused for market division:
- Visual exclusion: Products from competitors (called “renters”) were pushed to the sides of the shelves or even barred if they would interfere with the visibility of the 3 partners.
- Information Exchange: Partners gained detailed insights into the sales and placement of competitors' products.
- Enforcement: Pharmacies that did not adhere to the imposed planograms were dropped from the project. This led to a settlement, which is exceptional for ‘category management’ cases worldwide.
The wholesaler cartel and ‘transfer orders’
Higher up the chain, the BCA also intervened. In the case involving pharmaceutical wholesalers (Febelco, Pharma Belgium-Belmedis and CERP), the “Transfer Orders System” (TOS) was scrutinized. The TOS allows pharmacists to order directly from manufacturers on favorable terms, with the wholesaler handling only logistics and billing. The BCA found that wholesalers coordinated margins and services within this system to protect their central role in the chain and discourage direct sales by manufacturers.
Legal uniqueness: This was the first “hybrid” settlement in Belgium. While Febelco (immunity) and PBB settled, CERP contested the case, ultimately resulting in a fine of nearly 780,000 euros for an infringement “by object”.
Professional organizations as a brake on innovation
The BCA also targets professional associations that use their deontological powers for commercial purposes. The Order of Pharmacists was heavily sanctioned for antagonizing MediCare-Market, a new retail model. The Order used disciplinary procedures and lawsuits to counter this newcomer, under the guise of protecting public health. However, the BCA ruled that “public service” is not a valid excuse for restricting competition. In addition the Order was reprimanded for prohibiting advertising via Google AdWords and social media for non-drugs (parapharmacy), which proved an unjustified restriction on commercial freedom.
New in 2025: guidelines for combination therapies
There is also positive news: in September 2025, the BCA published guidelines for pharma companies working together on combination therapies (treatments that combine multiple agents). The BCA now provides legal certainty on what data may and may not be shared during reimbursement procedures:
- Admitted: Epidemiological data, patient data and therapeutic value.
- Prohibited: Net prices, margins, cost structures and distribution of therapeutic value among components.
2. Abuse of dominance
Companies with dominant market positions must be especially vigilant. The BCA focuses heavily on strategies that slow down or exclude competitors.
Disparagment: Novartis vs. Roche
Disparagment competitors is high on the radar. Novartis was fined 2.78 million euros for misleading doctors and hospitals about the risks of ‘off-label’ use of Avastin® (a Roche drug) for eye disease, in favor of its own (more expensive) drug Lucentis®. The BCA ruled that the warnings, given at a time when scientific studies already demonstrated the safety of Avastin®, were intended to foreclose the market. Interestingly, the fine was lower than in a similar French case because the BCA took into account the initial period of scientific uncertainty.
Market foreclosure biosimilars
The battle for biosimilars (cheaper biologics) rages fiercely. In March 2025, the BCA sent a communication of grievances to Roche. The suspicion is that Roche was implementing a strategy to delay the entry of biosimilars for its cancer drugs (MabThera® and Herceptin®). This is part of a broader policy by the Belgian government to accelerate the move to biosimilars in hospitals through mandatory tenders.
Pricing: excessive or legitimate?
Not every high price is an infringement. In the Leadiant case, concerning the orphan drug CDCA, the Belgian auditor - unlike colleagues in the Netherlands, Italy and Spain - decided not to prosecute for excessive prices. The reason was specifically Belgian: in our market, hospital pharmacies could more easily rely on compounded drugs as an alternative, thus limiting Leadiant's market power in practice.
Predatory pricing is also not always unlawful. In the case Docpharma / Eli Lilly a price cut of 80% by Eli Lilly, which pushed generic competitor Docpharma out of the market, was allowed by the president of the Brussels commercial court. The judge accepted the defense that Eli Lilly was merely liquidating its stock of an “end-of-life” product in response to new legislation, and did not intend to monopolize the market.
Parallel trade: refusal to supply is allowed (sometimes)
A common conflict involves parallel trade. May a manufacturer refuse supplies to a wholesaler who exports everything to more expensive countries? In the Bofar case the Competition Council confirmed (following the Syfait II ruling) that this is allowed under conditions. A dominant firm must honor “ordinary” orders for the domestic market, but may refuse orders that are disproportionate and clearly export-oriented. Bofar, which exported exclusively and did not serve the Belgian market, therefore could not force delivery.
3. Merger Control
The rules of the game around merger control have changed. Where previously only turnover thresholds were decisive, the BCA is now looking beyond.
Local markets remain crucial
Upon Multipharma's acquisition of 92 Popelin pharmacies, the BCA dove deep into local market analysis. The merger was only approved subject to divestments in specific municipalities (Mechelen and Willebroek) where market share would rise above 50%. In doing so, the BCA took into account the strict establishment laws and moratorium on new pharmacies, making new entry in those neighborhoods virtually impossible.
Hospitals
A political battle raged around hospital mergers. The legislature dramatically raised the turnover thresholds for notification requirements in 2024 (to €900 million combined turnover), which means that most hospital mergers are now outside the BCA's prior scrutiny. The BCA has publicly deplored this loss of authority and warns that it will use its “residual powers” to still intervene through retrospective investigations if there are abuses.
The ‘towercast’ doctrine: no more safe havens
The main warning for pharma companies is the application of the European Towercast ruling. This allows the BCA to investigate mergers that fall below the turnover thresholds (and are therefore not notifiable) as possible abuses of a dominant position. This is no longer a theory: the BCA already applied this in the Proximus/EDPnet case and in the food sector. For the pharmaceutical industry, this is crucial because of so-called “killer acquisitions”: buying up small, innovative start-ups to prevent future competition. Even if the acquisition target has low sales, the buyer now risks a retrospective investigation.
Frequently asked questions (FAQ)
Is it permissible to legally enforce my patents if their validity is challenged by a competitor?
Yes. In the case Merck Generics / MSD the competition authority confirmed that merely enforcing a patent or Supplementary Protection Certificate (SPC), even if the validity is challenged, is not an abuse of dominance. As long as the patent is not revoked, the holder has the right to defend his intellectual property.
I am a wholesaler/exporter and the manufacturer refuses to supply me. Is this an abuse?
It depends on your profile. If you are a wholesaler supplying the local market, a refusal to supply “regular” orders is often problematic. However, if you are a player focused purely on exports (as in the Bofar case), a manufacturer may restrict deliveries to protect its commercial interests from parallel trade, if proportionate.
As a pharmaceutical company, may I exchange information with a competitor for a combination therapy?
Yes, but under strict conditions. The 2025 BCA guidelines allow you to share data on epidemiology, patient numbers and therapeutic value. However, sharing information on net prices, margins or cost structures is strictly prohibited. The use of independent third parties or “clean teams” is strongly recommended.
My acquisition remains below turnover thresholds. Am I safe from a BCA investigation?
No, no longer. By applying the Towercast doctrine, the BCA can also investigate non-notifiable mergers if it suspects an abuse of dominance. This is especially true if you are acquiring an innovative competitor.
Conclusion
The Belgian Competition Authority's message is clear: the pharmaceutical sector remains “top of mind.” The authority is showing creativity in the use of its tools: from tackling category management and professional rules to deploying the Towercast-doctrine for small acquisitions. For market players, this means that compliance must go beyond standard contracts. Every consultation with competitors, every strategy around biosimilars and every distribution model requires a thorough competition law review.
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