The reference price system concerns reimbursable medicinal products to which generic substitution applies. In the reference price system, the highest price for which reimbursement can be paid has been determined for the medicine.
If the customer has been prescribed a product the price of which exceeds the reference price, the pharmacy must substitute the product for a product that has a price that is equivalent to the reference price or is cheaper than the reference price. However, the customer can prohibit the substitution. In such a case, reimbursement is paid on the reference price and the customer must pay the amount that exceeds the reference price himself or herself.
In generic substitution, the prescribed medicinal product is substituted at the pharmacy for a cheaper substitutable product. A product that is only included in generic substitution does not have a reference price. If the medicine that the customer buys is included in the reimbursement system, he or she will get reimbursement on the full price of the medicine.
The Pharmaceuticals Pricing Board (Hila) publishes a list of medicinal products subject to the price notification procedure 4 times a year. The price notification procedure concerns products included in generic substitution and the reference price system as well as products undergoing a so-called transition period.
A price notification must be submitted for any product subject to the price notification procedure to Kela at the latest 21 days before the first day of each quarter. If the product is subject to the price notification procedure under the reference price system and no notification is made about the product, the product becomes non-reimbursable at the beginning of the quarter.
On the basis of the prices notified, Kela determines the price bands. In addition, Kela forwards the price notifications to Hila for determination of the reference prices.
A price notification must be submitted to Kela for any product subject to the price notification procedure even though the price of the product does not change. If the product is subject to the price notification procedure under the reference price system and no notification is made about the product, the product becomes non-reimbursable at the beginning of the quarter.
Generally available means that the product is available from the wholesalers at the time of notification and throughout the following quarter. It is important that the information in the price notification regarding the availability of the product is correct so that the cheapest price of the group of substitutable packages and the price band calculated on the basis of this lowest price are based on actual data on availability.
Submit a price notification for the product to Kela at the latest 21 days before the first day of the quarter. If you do not submit a notification, the product becomes non-reimbursable at the beginning of the quarter.
If the wholesale price of the product is not known, you can state EUR 0.00 as the wholesale price. In that case, you will have to indicate No as data on availability.
You can cancel the reimbursability on the price notification you submit to Kela. State a higher wholesale price for the product than the confirmed maximum wholesale price and tick the section The product is withdrawn from the reimbursement system.
If none of the products in the group of substitutable packages is available throughout the quarter, Kela determines a technical price band on the basis of the cheapest reported price. In that way we can ensure that the pharmacy can substitute the medicines during the time they are available.
Submit a price notification to Kela in accordance with the schedule for quarterly notifications. If Hila confirms a lower wholesale price for the product than the reported wholesale price after the time period for filing price notifications, you must contact Kela. The wholesale price stated in the price notification must be adjusted so that it corresponds to the decision by Hila in order for the reimbursability of the product to continue.
If the product is included on Fimea’s list, you must submit a price notification for the product to Kela at the latest 21 days before the first day of the quarter. It is not possible to report prices that take effect at the beginning of the quarter to Kela or to the pharmacy price lists after this specified date.
If the product is not included on Fimea’s list, you must submit a price notification to the Pharmaceutical Information Centre, the Association of Finnish Pharmacies and Yliopiston Apteekki in accordance with their instructions.