Additional benefit for 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:
Base amount of the supplementary benefit for medicinal product NB! This amount is always lower than the amount spent on discount prescriptions. | = | The amount spent on discount medicines The costs of over-the-counter medicines, medical devices, and non-discount medicines will not be taken into account. The part of the price of medicines that exceeds the price of a reference price or the price agreement price |
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:
| The amount spent on medicinal products | The Health Insurance Fund will compensate | Example |
|---|---|---|
Less than 100 euros
| Supplementary benefit for medicinal products is not taken into account
| Supplementary benefit for medicinal products is not taken into account
|
100 to 300 euros
| 50% of the amount exceeding EUR 100 | For example, if a person purchases a number of discount medicines in a calendar year and with this purchase, the base amount of his or her personal amount of supplementary benefit for medicinal products will increase to EUR 105, then he or she will be granted a supplementary benefit of 50% for the EUR 5 exceeding the EUR 100, and the person will pay EUR 2.5 less in the pharmacy. If a person has spent EUR 250 on medicines, we will deduct EUR 100 from this amount for the additional benefit, which is the minimum payment threshold, and we will make a calculation of 150x50% = EUR 75. |
More than 300 euros
| 90% of the amount exceeding EUR 300
| If the base amount of the supplementary benefit for medicinal products was 300 before the purchase and a medicinal product was purchased, which raised the base amount to 320, the supplementary benefit will be paid at 90% of the amount exceeding EUR 300 (90% of 20 = EUR 18) and the person will pay 18 euros less in the pharmacy . It is essential to keep in mind that from 100 to 300 euros, 50% benefit has already been received from previous purchases. However, if before the purchase, the base amount was EUR 90, and an expensive medicine was purchased, which raised the base amount to EUR 500, a person will receive a supplementary benefit of EUR 280 (i.e., 50% of the difference of EUR 100 and EUR 300 (EUR 100) + 90% of the amount which exceeds EUR 300 (90 % from 200 = EUR 180) |
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.