Supplementary benefit for medicinal products and medical devices
Supplementary benefit for medicinal products and medical devices (in effect from 1 January 2025
People who spend more than average on medicinal products and medical devices get a greater discount from pharmacies and companies selling medical devices. In addition to the normal discount on medicinal products and medical devices, there is a supplementary benefit for medicinal products and medical devices (hereinafter ‘the supplementary benefit’).
The supplementary benefit is paid to insured persons who pay at least 100 euros per calendar year for discounted prescriptions (not including the amount exceeding the maximum price).
How is the supplementary benefit calculated?
The supplementary benefit applies to expenses made on medicinal products with an EHIF discount and on medical devices. This means that expenses made on over-the-counter medicines (non-prescription drugs) and prescription drugs that do not qualify for the EHIF discount are not taken into account. The benefit of the Health Insurance Fund also does not apply to discounted technical aids, which are reimbursed by the Social Insurance Board.
The supplementary benefit is calculated on the basis of expenses accrued in a calendar year. A prescription fee of €2.5 that applies when buying medicinal products is also taken into account.
The following principles apply to the reimbursement of medicinal products and medical devices purchased with discount prescriptions:
1. if the amount remains below 100 euros per year, no supplementary benefit is paid
2. if the amount is 100–300 euros per year, 50% of the amount exceeding EUR 100 will be reimbursed
3. if the amount exceeds 300 euros per year, 90% of the amount exceeding EUR 300 will be reimbursed
For example, if a person has spent 250 euros on medicinal products and medical devices, they 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 reimburse 90% of the out-of-pocket cost of the medicinal product or medical device. For example, if a person has spent 500 euros, they will receive a discount of 280 euros.
Calculation of the supplementary benefit for medicinal products and medical devices
1. First, the initial amount of the supplementary benefit for medicinal products and medical devices for the calendar year is calculated:
| Base amount of the supplementary benefit for medicinal products and medical devices. Please note! This amount is always lower than the amount spent on discount prescriptions. | = | The amount spent on discount medicinal products and medical devices. The costs of over-the-counter medicines, technical aids of the Social Insurance Board, and non-discount medicinal products and medical devices will not be taken into account. | - | The part of the price of medicinal products and medical devices that exceeds the reference price or the agreed price. |
2. If the base amount of the supplementary benefit for medicinal products and medical devices is known, the supplementary benefit for medicinal products and medical devices will be calculated as follows:
| The amount spent on medicinal products and medical devices | The Health Insurance Fund will reimburse | Example |
|---|---|---|
| Less than 100 euros | The supplementary benefit is not calculated | For example, if a person purchases a number of discount medicinal products and medical devices in a calendar year and the total out-of-pocket costs for these purchases amount to 120 euros, of which the unavoidable out-of-pocket costs are 80 euros (i.e. the person has also bought products that are more expensive than the reference price), the supplementary benefit will not be calculated. |
| 100 to 300 euros | 50% of the amount exceeding 100 euros | For example, if a person purchases a number of discount medicinal products and medical devices in a calendar year and with this purchase, the base amount of their personal supplementary benefit will increase to 105 euros, then they will be granted a supplementary benefit of 50% for the 5 euros exceeding 100 euros, and the person will pay 2.5 euros less at the pharmacy. If a person has spent 250 euros on medicinal products and medical devices, we will deduct 100 euros from this amount for the supplementary benefit, which is the minimum payment threshold, and make a calculation of 150 × 50% = 75 euros. |
| More than 300 euros | 90% of the amount exceeding 300 euros | If the base amount of the supplementary benefit was 300 before the purchase and a medicinal product or medical device was purchased which raised the base amount to 320, the supplementary benefit will be paid at 90% of the amount exceeding 300 euros (90% of 20 = 18 euros) and the person will pay 18 euros less at the pharmacy or the company selling medical devices. It is essential to keep in mind that from 100 to 300 euros, the 50% benefit has already been received from previous purchases. However, if the base amount was 90 euros before the purchase and an expensive medicinal product or medical device was purchased which raised the base amount to 500 euros, the person will receive a supplementary benefit of 280 euros (i.e. 50% of the difference of 100 euros and 300 euros (i.e. 200 euros, of which 50% is 100 euros) + 90% of the amount which exceeds 300 euros (90 % of 200 = 180 euros) |
Please note! The amount exceeding the reference price or the agreed price (the avoidable out-of-pocket cost) will be deducted from the amount spent on medicinal products and medical devices before the calculation of the supplementary benefit. 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 5 euros, 7 euros, and 9 euros, then the reference price will generally be the price of the second most affordable medicine (7 euros in this example) and the benefit percentage of the Health Insurance Fund will be calculated from this amount. If the purchaser of a medicinal product prefers a more expensive medicine, the part exceeding the reference price must be paid at the pharmacy in addition to the established out-of-pocket cost (2 euros in this example).
A similar principle applies to medical devices. If there are several comparable devices in the list of medical devices in the same medical device reference price group, the reference price is the reference price of the second most affordable medical device, from which the benefit percentage of the Health Insurance Fund is calculated. For example, if medical device sellers offer different glucometer test strips at 15 euros, 16 euros, and 19 euros, the reference price is set at 16 euros and the benefit percentage of the Health Insurance Fund is calculated from this amount. If the purchaser prefers a more expensive medical device, the part exceeding the reference price must be paid in addition to the established out-of-pocket cost (3 euros in this example).