The annual maximum limit on out-of-pocket medicine costs

The annual maximum limit on out-of-pocket medicine costs refers to the maximum amount that you have to pay for your medicines in one calendar year (1 January to 31 December). 

What medicines count towards the annual maximum?

All the medicines you buy that are covered by the medicine reimbursement system and have been prescribed for you for the treatment of an illness count towards the annual maximum limit on out-of-pocket costs. Any medicine costs you have paid that count towards the initial deductible also count toward the annual maximum, as do the medicine costs you pay yourself after the deduction of reimbursements.

However, if the price of a medicine exceeds its reference price, the exceeding part does not count towards the annual maximum.

You also make progress towards the annual maximum limit on out-of-pocket costs when you purchase medicines that

• have been paid for by a workplace sickness fund
• Kela or the municipality has paid for as part of social assistance
• have been reimbursed through voluntary insurance.

The annual maximum does not include medicines that you have received free of charge from a pharmacy (for example due to a traffic accident or an accident at work).

You get an additional reimbursement when the annual maximum has been reached

Once you have reached the annual maximum limit on out-of-pocket costs, you can get an additional reimbursement. This means that you only have to pay a copayment of EUR 2.50 for each prescription medicine you buy during the rest of the year. If the price of the medicine you have been prescribed exceeds its reference price and you do not agree to have the medicine switched for a less expensive alternative (generic substitution), you will have to pay the amount that exceeds the reference price, in addition to the EUR 2.50 copayment.

When you reach the annual maximum limit, the pharmacy receives the information from Kela immediately when you make your purchase.