Contents
All medicines available on the market can be divided according to the entity responsible for paying for them. In this respect, we distinguish drugs that are fully reimbursed, drugs that are partially reimbursed and drugs that are not reimbursed by the National Health Fund. We can buy partially or fully refunded drugs with a corresponding discount on the basis of a prescription received from a doctor.
What you should know about reimbursed drugs
The list of drugs subject to reimbursement, along with the amount reimbursed by the National Health Fund, is established by the Minister of Health and published in the form of an appropriate regulation. The basis for the preparation of this document are specialized economic and pharmacological analyzes, determining the current social demand for individual drugs and an assessment of the level of their effectiveness.
All pharmacies in Poland selling reimbursed drugs have signed an agreement with the National Health Fund. Thanks to this, when purchasing a reimbursed drug in them, part of the amount (or its entirety) is covered from the fund.
Who can issue a drug and who can get a refund?
The right to issue a prescription for a fully or partially reimbursed drug is granted to all licensed doctors working in Poland, both for the units of the National Health Fund and for private institutions. The legal basis is Art. 34 of the Act on health care services financed from public funds.
The condition for receiving a reimbursed drug is to present an appropriate prescription to the pharmacy. A correctly completed prescription should contain: the patient’s address, PESEL number, identification number of the National Health Fund (NFZ) department, date of issue and delivery of the prescription. It is also important to know about the facility and the doctor who issues the prescription; this information should be provided in the form of an overprint or stamp. Due to problems with settling reimbursed drugs, a valid prescription must contain the name and surname of the doctor and the number indicating the right to practice. In addition, a correctly completed prescription should be free from errors (especially typos that may make it difficult to read the name of the drug) and be legible.
In order for a patient to receive a prescription for a reimbursed drug, several important conditions must be met. First, the granting of such a drug must be justified by the patient’s health condition, for example – the prescribed reimbursed drug must be related to the disease from which the patient suffers. Equally important, the patient must provide appropriate health services or otherwise be insured by the National Health Fund. To obtain a prescription for a reimbursed drug, you must present the doctor with a document confirming the payment of contributions (e.g. a monthly report from ZUS RMUA).
What drugs are reimbursed?
Reimbursable drugs can be divided into four general groups:
- basic, life-saving drugs necessary to carry out a specific therapeutic therapy,
- drugs that support, complement or effect the action of basic drugs,
- drugs and other medical devices used in the treatment of selected chronic diseases,
- prescription drugs (“unfinished”) with a dose lower than the smallest dose of a ready-made drug (solid, oral), among those registered on the pharmaceutical market.
Medicines reimbursed in 2019
In December 2018, the Ministry of Health announced the list of reimbursed drugs, effective from January 1, 2019. Compared to the previous year, not only the list itself and the preparations present on it have changed, but also the prices of individual drugs. First of all, there were more drugs for muscle wasting, lung cancer and leukemia; including drugs dedicated to seniors and the youngest patients. The prices of a significant part of the drugs have decreased. For 1371 medicines, the official selling price was lowered, and for another 2382, the level of retail prices was lowered. Only 296 drugs will be more expensive than last year. However, price increases are extremely low and range from PLN 1 to PLN 1,11.
The new items on the list of reimbursed drugs include Venclyxto, used in the treatment of some severe forms of leukemia. Also Xalkori and Tecentriq are two new items on the list; both drugs are used to treat different types of non-small cell lung cancer. In addition, the list of reimbursed drugs includes Spinraza, intended for people suffering from spinal muscular atrophy. It is estimated that all patients in Poland suffering from this disease (approx. 700 people) will have free access to Spinrazy.