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Cost sharing for prescription medicines

Kela provides reimbursement for part of the cost of medicines, emollient creams and clinical nutrients that are covered by the reimbursement system. You always pay some of the cost yourself in the form of a copayment or deductible.

Initial deductible

You can get a reimbursement for your medicine expenses once you have met the annual initial deductible. Its amount is EUR 50.

Children and youth are exempt from the initial deductible. It is applicable from the beginning of the year during which a young person turns 19.

Any medicines, emollient creams or clinical nutrients included in the reimbursement scheme that you purchase on prescription count towards the initial deductible.

If the sales price of the medicine is higher than the reference price, the exceeding part does not count towards the initial deductible.

Kela and pharmacies have up-to-date information about how much you have paid towards the initial deductible. As soon as you have paid 50 euros, you will get the reimbursement due to you at the pharmacy.

Reimbursements after meeting the initial deductible

Once you have met the initial deductible, you will start getting the reimbursements due to you for your medicine purchases. There are three reimbursement categories:

  • The basic rate of reimbursement is 40% of a medicine’s sales price or reference price.
  • The lower special rate of reimbursement is 65% of a medicine’s sales price or reference price.
  • The higher special rate of reimbursement is 100% of a medicine’s sales price or reference price.
    • You pay a copayment of EUR 4.50 each time you buy a medicine.

You buy 3 different medicines at the same time, and

  • one of them costs 25 euros and is reimbursed at the basic rate.
  • for the second medicine you are reimbursed at the lower special rate. This medicine costs 20 euros. 
  • for the third one you are reimbursed at the higher special rate. This medicine costs 105 euros.

Your payments count towards the initial deductible in the following way:

  1. The medicine that is reimbursed at the basic rate costs 25 euros, all of which counts towards the initial deductible.
  2. The medicine that is reimbursed at the lower special rate costs 20 euros, all of which counts towards the initial deductible.
  3. You have now paid a total of 45 euros towards the initial deductible.
  4. The medicine that is reimbursed at the higher special rate costs 105 euros, of which 5 euros counts towards the initial deductible. At this point, you have met the EUR 50 initial deductible.
  5. There is still 100 euros left in the price of the medicine that is reimbursed at the higher special rate. You do not have to pay it, because the initial deductible has been met and you get a reimbursement for 100% of the medicine’s price. You only pay a copayment of EUR 4.50.
  6. For this visit to the pharmacy, the price you pay for your medicines comes to a total of EUR 54.50 (the initial deductible + per-medicine copayment).

Annual maximum limit on out-of-pocket costs

The annual maximum limit on out-of-pocket costs refers to the maximum amount that you have to pay for your reimbursable medicines in one calendar year.

Exceptional copayment rate for specific medicines

In certain situations, if you are entitled to a reimbursement at the higher special rate or you have met the annual maximum limit on out-of-pocket costs, you pay the copayment at an exceptional rate when buying specific medicines.

The exceptional copayment rate for specific medicines applies in situations where it is not possible for you to buy 3 months’ supply of the medicine at one time.

Read more about how often you can buy reimbursable medicines.

You pay the copayment at an exceptional rate when you buy

  • an expensive medicine (medicines that are available in package sizes that cost more than EUR 1,000)
  • a medicine that the pharmacy dispenses broken down into single doses
  • clozapine, peritoneal dialysis solution or medical oxygen
  • a medicine that is dispensed in several batches due to its short shelf-life
  • a medicine that your doctor has ordered to be dispensed in several batches.

If you are paying the copayment at an exceptional rate, you must pay it separately for each week you buy the medicine for.

  • If you are reimbursed for the medicine at the higher special rate, the copayment is EUR 0.38 per week. If you have reached the annual maximum limit on out-of-pocket costs, the copayment is EUR 0.21 per week.

Read more

Last modified 22/2/2024

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