Prescription Costs
As with consultations, prescription medicines are eligible for a refund from the health service. However, the refund systems do not work in the same way. If you have a consultation, you will pay the full charge and be refunded a percentage, typically 70%, afterwards. In contrast, medicines which entitle you to a refund are featured on a fixed legal list called the 'list of refundable medicines for the insured'. These medicines are eligible for a refund only if they are prescribed by a doctor, a midwife, a dental surgeon or a laboratory analyst.
Refund rates
Medicine refunds depend on the therapeutic use of the medicine itself. Medicines carry stickers of different colours to indicate their refund rate:
Blocked white stickers indicate a 100% refund rate. These usually apply to very expensive medicines for serious illnesses.
White stickers indicate a 65% refund rate, applicable to most medicines.
Blue stickers indicate a 35% refund rate, for medicines to treat basic illness.
Orange stickers indicate a 15% refund rate, for medicines whose therapeutic interest is considered insufficient or unproven.
These refund rates are calculated in line with the maximum sale price of the medicine or the fixed 'price list of responsibility', the TFR.
TFR
The TFR, or 'Tarif Forfaitaire de Responsabilité', was created by the Ministry of Health to promote generic medicines. It dictates that non-generic medicine will be eligible for a refund calculated in line with the basic price of the cheapest equivalent generic medicine: the patient must pay any price difference themselves.
A generic medicine is a medicine produced under the name of its active substance, such as paracetamol, rather than a brand name, whilst retaining the same or similar formula as the equivalent medicine produced by brand name laboratories. This is possible only when the medicine's patent is in the public domain.
Non-refunded medicine costs
The decision not to refund the cost of certain medicines was taken by the health authorities, and is based on the unproven therapeutic usefulness of these medicines.
The cost of certain innovative but very expensive medicines is refunded by the health authorities, who choose to cover the cost of expensive drugs that in trial have been proven useful, rather than the cost of other drugs whose effectiveness is as yet unproven. Your doctor or pharmacist can inform you as to which medicines are refunded and which are not: they may also be able to explain why a particular drug is not eligible for a refund.
