Medicines are reimbursed in three categories:
- The basic reimbursement is 40 % of the medicine’s price or reference price.
- The lower special reimbursement is 65 % of the medicine’s price or reference price
- The higher special reimbursement is 100 % of the medicine’s price or reference price for the portion that exceeds the medicine-specific copayment of EUR 4,50.
In order to receive special compensation, Kela must grant you the right to special reimbursement. You can apply for the right to special reimbursement by delivering a doctor’s statement to Kela (doctor’s statement B for Finnish health care).
At any one time, Kela can only reimburse a quantity of medication equivalent to three months of treatment.
- A larger quantity of medication can only be reimbursed for a special reason, such as an extended stay abroad.
- You must first pay the costs of the larger quantity yourself. You can then apply for retroactive reimbursement from Kela.
In 2016, there will be a maximum limit on out-of-pocket medicine expenses of EUR 610,37 and an initial deductible of EUR 50.
The Pharmaceuticals Pricing Board decides on the reimbursability of medicines
The Pharmaceuticals Pricing Board (HILA), which operates in conjunction with the Ministry of Social Affairs and Health, decides on the reimbursability and fair wholesale pricing of medicines, basic ointments and clinical nutritional products. To be eligible for reimbursement, a product must be accepted for reimbursement by the Pharmaceuticals Pricing Board. If a medicine is not accepted for reimbursement, the client must pay the full price.
The amount of the reimbursement is also affected by whether or not the medicine belongs to the reference price system. When a medicine belongs to the reference price system, Kela pays compensation in accordance with the reference price. The Pharmaceuticals Pricing Board confirms the reference prices for medicinal products.
You can use the Medicinal Products Database to check the prices of medicines and information on reimbursements and possible substitutes.
You can normally exchange a medicine prescribed by a doctor for a more affordable alternative product at a pharmacy.