Can you get reimbursement for medicine costs?
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You pay the initial deductible yourself to begin with
You can get reimbursements once your total medicine costs reach a specific amount. This amount is called the initial deductible and it is EUR 70. The initial deductible applies to one calendar year at a time. Reimbursement for your prescription medicines is usually provided to you directly at the pharmacy. The reimbursement is deducted from the price of the medicine at the pharmacy.
What medicines can you get reimbursement for?
You can be reimbursed for the cost of medicines that are covered by the medicine reimbursement system and have been prescribed to you for the treatment of an illness.
You will get reimbursement at the basic rate if the Pharmaceuticals Pricing Board (Hila) has confirmed that your medicine is reimbursable at the basic rate. The basic rate of reimbursement is 40% of a medicine’s sales price or reference price.
If Hila has decided that a medicine can be reimbursed at the basic rate only when it is prescribed for certain medical conditions, you must apply for the right to reimbursement separately from Kela.
How to apply for the right to reimbursement for a medicine with limited basic reimbursability.
You can get reimbursement for some medicines at a higher rate than the basic rate. A medicine can be reimbursed at a special rate, if the Pharmaceuticals Pricing Board (Hila) has confirmed its status as reimbursable at a special rate.
- The lower special rate of reimbursement is 65% of a medicine’s sales price or reference price.
- The higher special rate of reimbursement is 100% of a medicine’s sales price or reference price.
- However, you will still pay a copayment of EUR 4.50 each time you buy a medicine reimbursable at 100%.
You have to apply separately for the right to reimbursement at a special rate.
How to apply for the right to reimbursement at a special rate.
You can claim reimbursement for a clinical nutrition product if you have a prescription for it and you are buying it from a pharmacy. An additional condition for reimbursement is that the Pharmaceuticals Pricing Board (Hila) has confirmed its status as reimbursable. The reimbursement is 40% or 65% of the product’s sales price.
You can be reimbursed for the cost of a clinical nutrition product only if Kela has granted you a right to reimbursement. You have to apply separately to Kela for the right to reimbursement.
How to apply for the right to reimbursement for a clinical nutrition product.
You can claim reimbursement for an emollient cream that you have a prescription for and that you buy from a pharmacy, if the Pharmaceuticals Pricing Board (Hila) has confirmed its status as reimbursable. The reimbursement is 40% of the product’s sales price. You can get the reimbursement on the condition that the healthcare professional who prescribed you the emollient cream has indicated in the prescription that the product is intended for a “pitkäaikainen ihotauti” (chronic skin condition).
If you buy medical oxygen, oxygen containers or liquid oxygen units on prescription, Kela will reimburse you for 40% of the costs.
There can be situations where there are no medicines with marketing authorisation available for treatment of an illness or where the medicines with marketing authorisation do not yield the desired effect. In such a case, your doctor may prescribe you a medicine which requires a special permit from the Finnish Medicines Agency (Fimea).
Read more about medicinal products that require a special permit and reimbursements for them.
Look up the price and reimbursement status of medicines and their generic alternatives
Reimbursement for a maximum of 3 months’ supply of medicine
You can get a reimbursement for a maximum of 100 days’ (approximately 3 months) supply of a medicine when making a purchase. The pharmacy will calculate a 3 months’ supply of the medicine based on the dosage in your prescription. However, the amount of the medicine may also be less than that depending on the package sizes your medicine is available in.
If you are purchasing an expensive medicine, you can get a reimbursement for a maximum of 1 month’s supply of the medicine at a time.
Example 1
The prescribed dose of your medicine is 1 tablet once a day. The medicine is sold in package sizes of 100 tablets and 30 tablets. You can get a reimbursement for a maximum of 100 tablets at a time.
Example 2
The prescribed dose of your medicine is 0.5 tablet once a day. The medicine is sold in package sizes of 100 tablets and 30 tablets. You can get a reimbursement for a maximum of 30 tablets at a time.
When can you buy more of a reimbursable medicine?
You can get a reimbursement for a new batch of medicine after you have used nearly all of your previously bought medicine.
When you buy more medicine, the earliest you can get a reimbursement for a new batch is
- 3 weeks before the previous batch runs out, if you previously purchased a 3 months’ supply
- 2 weeks before the previous batch runs out, if you previously purchased a 2 months’ supply
- 1 week before the previous batch runs out, if you previously purchased a 1 month’s supply or less.
Based on the dosage in your prescription, the pharmacy calculates whether enough time has passed since your previous purchase and whether you can receive a direct reimbursement for a new batch of medicine.
Please note that if a package of medicine is damaged, lost or stolen, or if the medicine loses its effectiveness due to incorrect storage, Kela will usually not reimburse you for any medicine bought in replacement.
Why are some medicines not reimbursable?
Kela only reimburses medicines that are covered by the medicine reimbursement system.
You cannot get a reimbursement for a medicine if the pharmaceutical company that manufactures it
- has not applied for its inclusion in the reimbursement system
- has not applied for an extension to its inclusion in the reimbursement system
- has applied for its inclusion in the reimbursement system, but Hila has rejected the application
- has withdrawn it from the reimbursement system.