Reimbursement of medicines

Verified 31 March 2024 - Directorate for Legal and Administrative Information (Prime Minister)

Want to know how much medication is reimbursed? The Health Insurance (Social Security) pays for all or part of the medicines purchased in pharmacies. This depends both on the medicine concerned and on the conditions of prescription and dispensing. The rate of reimbursement depends on the medical service rendered, that is to say on the interest that this medicine has from a medical point of view. Here are the rules to know.

3 cumulative conditions must be met for a refund.

FYI  

There are times when the health department will stop reimbursing a drug. This may be the case, for example, if the medical utility is no longer demonstrated.

Listed medicinal products

To be reimbursed, the drug must be listed on the list of reimbursable medicinal products.

Please note

Since 2021, homeopathic medicines and homeopathic magistral preparations (HMPs) are no longer reimbursed by Health Insurance.

Prescription by a healthcare professional

The medicine should be prescribed by a healthcare professional, within the limits of his rights of limitation :

  • Doctor
  • Midwife
  • Dental surgeon
  • Podiatrist
  • Nurse

The prescription must be made on a ordinance in accordance with the regulations. Thus, certain particulars are mandatory (posology and duration of treatment or number of boxes or vials, for example).

If it is a so-called exception drug, the prescription is made on a specific print called prescription of drugs or products and emergency benefits. Medicinal products known as exceptional are particularly expensive.

Dispensing by pharmacist

The pharmacist delivers the medication to you.

In principle, the pharmacist can supply you with a quantity of medicines corresponding to a treatment of a maximum duration of 1 month (except for example for a departure abroad of more than 1 month).

Other issuing rules may apply depending on the situation.

FYI  

one corresponding pharmacist may renew a prescription for the treatment of long-term illness and, if necessary, adjust the posology.

In the event of a shortage of a medicinal product of major therapeutic interest, the pharmacist may replace the prescribed medicinal product by another medicinal product. He writes the name of the medicine he has dispensed on the prescription and informs the doctor of this replacement.

Please note

For certain conditions, the pharmacist may dispense certain non-prescription medicines.

Dispensing these drugs requires that the patient’s treating physician be informed.

To be reimbursed, the care sheet must be sent to your health insurance organization (the pharmacist automatically sends it electronically).

For some drugs, a request for prior agreement with your health insurance organization.

You can take advantage of the third-party with most pharmacists.

If you refuse a generic drug, you'll get less money back.

FYI  

Remember to update your Vital Card at least once a year or when your situation changes (e.g. move).

Information about the price and reimbursement rate for each drug is included on an invoice printed by the pharmacist on the back of the prescription (called invoice) Vital ticket).

In the pharmacy, depending on whether the reimbursable drug is on display to the public, the price is indicated by:

  • Display
  • Label
  • Freely accessible catalog
  • Or Internet interface providing access to a national baseline.

Classification of medicinal products

Medicinal products are divided into several categories, based on, inter alia, their medical service rendered (MRS.): major or significant MRS., moderate MRS., low MRS.

Tableau - Reimbursement rates for drugs based on MRS.

Categories of medicinal products

Reimbursement rate

Irreplaceable and expensive drug

100%

Major or significant MRS. drug

65%

Moderate MRS. drug and certain magistral preparations

30%

Low SMR. drug

15%

The refund rate shall apply on the basis of:

  • The selling price (price fixed by regulation)
  • Or a flat liability rate (a reference rate for reimbursement of certain medicines)

Please note

Nicotine replacement products on the list of nicotine replacement products reimbursed shall be reimbursed to 65% on medical prescription.

Medical deductible

One frankness of €1.00 is deducted from the medicines reimbursed by the Health Insurance (directly from the reimbursement statement).

The amount of the medical deductible shall not exceed €50 per year per person.

Example :

If you buy a box of medicines for an amount of €20, and that this medicinal product is reimbursed to 65%, Health Insurance will reimburse you €12. Calculation detail: €13 (65% of €20) which are removed €1.00 of frankness.

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