Reimbursement of pharmaceuticals

How is the supplementary benefit for medicinal product calculated?

The supplementary benefit for medicinal products applies to expenses on discount medicinal products. This means that the costs of over-the-counter medicines (non-prescription drugs) and prescription drugs that do not qualify for a health insurance fund benefits, or medical devices are not taken into account.

Supplementary benefits for medicinal products is calculated on the basis of expenses accrued per the calendar year. 

The following principles apply to the benefits of medicines purchased with discount prescriptions:

1 ) If the amount remains below EUR 100 per year, no supplementary benefit for medicinal products

2 ) If the amount is EUR 100-300 per year, 50% of the amount exceeding EUR 100 will be compensated for

3 ) If the amount exceeds EUR 300 per year, 90% of the amount exceeding EUR 300 will be compensated for

The Health Insurance Fund will start compensating for costs starting from EUR 100 euros.  In the range between EUR 100-300, a 50% discount will apply. For example, if a person has spent EUR 250 on medicinal products, he or she will receive a discount of 75 euros from the Health Insurance Fund. In cases of expenses exceeding EUR 300 euros, the Health Insurance Fund will pay 90% of the cost. For example, if a person has spent EUR 500, he or she will receive a discount of EUR 280

Calculation of the supplementary benefit for medicinal products

1 ) First, the initial amount of the supplementary  benefit for medicinal products for the calendar year is calculated:

2)  If the base amount of the supplementary benefit of the medicinal product is known, the supplementary benefit for the medicinal product will be calculated as follows:

NB!  The amount exceeding the reference price or the agreed price or the avoidable cost-sharing will be deducted from the amount spent on medicinal products before calculation of the supplementary benefit for the medicinal products.  If there are many medicinal products with the same active substance in the market from different manufacturers, a reference price for the whole group of medicines with the same active substance will be established, from which the EHIF discount will be calculated.  For example, if a pharmacy has a selection of medicines with the same active substance at a price of EUR 5, EUR 7 and EUR 9, then the reference price will generally be the price of the second most affordable medicine (for this example, EUR 7) and a the benefit percentage of the Health Insurance Fund will be calculated from this amount.  In case the purchaser of a medicinal product prefers more expensive medicine, the part exceeding the reference price must be paid in the pharmacy in addition to the established cost sharing.

Very rarely, it may occur that even though a person has the right to receive supplementary benefits, it is not possible to make an additional discount for this (as may happen, for example, at the end of the year), then a person will receive a higher benefit in the following calendar year.

The pharmacy offers a 100% discount for pharmaceuticals that contain the following active ingredients:

• follitropin alpha;
• follitropin beta;
• ganirelix;
• goserelin;
• triptorelin;
• cetrorelix;
• lutropin;
• corifollitropin;
• chorionic gonadotropin alpha.