Reimbursements for medicine expenses
You can be reimbursed for medicines, clinical nutrients and emollient creams prescribed to you for the treatment of an illness. Reimbursements are only available for products confirmed as reimbursable by the Pharmaceuticals Pricing Board (Hila), which operates in connection with the Ministry of Social Affairs and Health.
Usually, the reimbursement is provided to you directly at the pharmacy.
Reimbursement after meeting the initial deductible
You can be reimbursed for the medicines you purchase once you have met the initial deductible, which is EUR 50 per calendar year.
Children and adolescents are exempt from the initial deductible. It is applied from the beginning of the year in which you reach the age of 19.
You can usually get a reimbursement directly at the pharmacy. The pharmacy contacts Kela electronically to check your eligibility. The pharmacy also has up-to-date information about your progress towards meeting the initial deductible.
You can only be reimbursed for necessary medicine costs. This means that you can buy medicine for no more than 3 months of treatment at one time.
The amount of medicine dispensed is calculated according to the dosage instructions listed in the prescription. For medicines which are taken according to a daily schedule, an amount of medicine for three months’ use is equal to a 90-day period of treatment. The amount of medicine dispensed may be slightly larger or smaller than this depending on the availability of package sizes.
Example 1: The prescribed dose of your medicine is 1 tablet once a day. There are two package sizes: 100 tablets and 30 tablets. The maximum amount you can buy at a time and receive a reimbursement is 100 tablets.
Example 2: The prescribed dose of your medicine is 0.5 tablet once a day. There are two package sizes: 100 tablets and 30 tablets. The maximum amount you can buy at a time and receive a reimbursement is 30 tablets.
If the medicine you have been prescribed is particularly expensive, you can, at one time, only buy one package of that medicine, equivalent to no more than 1 month of treatment, for which you are reimbursed directly. Particularly expensive medicines refer to medicines the retail price of which, including value-added tax, exceeds EUR 1,000 for one package.
- At the beginning of 2018, it is possible to buy, at one time, a supply of expensive medication that exceeds the annual maximum limit on out-of-pocket medicine costs.
You can get a new reimbursement only after you have used nearly all of the previous batch of medicine, clinical nutrient or emollient cream.
The earliest that you can get a reimbursement for a new batch is:
- three weeks before the previous batch will run out, assuming that the previous batch contained medicine in an amount equivalent to three months’ use.
- two weeks before the previous batch will run out, assuming that the previous batch contained medicine in an amount equivalent to two months’ use.
- one week before the previous batch will run out, assuming that the previous batch contained medicine in an amount equivalent to one month’s use or less.
When dispensing the medication, your pharmacy will check whether a new batch can be dispensed under the reimbursement rules. For example, if you bought medicine for three months’ use when you last were at the pharmacy, you can buy a new batch and get a reimbursement for it when you have no more than three weeks’ worth of medicine left.
The rate of reimbursement depends on the reimbursement category to which the product you are buying belongs. There are three categories:
- Basic rate of reimbursement 40%
- Lower special rate of reimbursement 65%
- Higher special rate of reimbursement 100%. A copayment of EUR 4.50 per medicine and per purchase is charged.
The reimbursement is deducted from the price of the medicine. If the medicine is included in the reference price system, you will not be reimbursed for the part of the price that exceeds the reference price.
Annual maximum limit on out-of-pocket costs
Any prescription medicine costs you pay yourself count towards an annual maximum limit on out-of-pocket costs. The initial deductible also counts towards the annual out-of-pocket maximum.
In 2019 the annual maximum is set at EUR 572. If you exceed the annual maximum, you can get an additional reimbursement, which means that for the rest of the year, you only pay a EUR 2.50 copayment for each reimbursable medicine.