Download Download

Patient contributions to the costs of reimbursed pharmaceuticals, 2012
Cost-sharing requirements
Belgium
Co-insurance rate, with different levels across categories, with a cap per prescription.
Co-insurance rate is 0% for vital pharmaceuticals, 25% for therapeutically important drugs; 50%
for pharmaceuticals for symptomatic treatment, 60% for influenza vaccines and antihistamines
and 80% for contraceptive medicines.
Denmark
Deductible of DKK 820 and decreasing co-insurance rate linked to accumulated OOP spending
in 1 year. Reimbursement rate is 50% up to DKK 1,340, then 75% up to DKK 2,885, then 85%
up to DKK 3,370. Beyond that level, the patient can apply for 100% reimbursement for the rest
of the year.
France
Co-insurance rates of 35%, 70% or 85% depending on drug categories + copayment of
EUR 50/Rx capped to EUR 50 per year. Exemptions for some categories of patients and full
reimbursement for some drugs.
Germany
10% co-insurance (with a minimum of EUR 5 and a maximum of EUR 10 per prescription).
Italy
Co-payments per prescription set at regional level, with possible adjustments for population
categories (e.g. based on specific clinical condition, age and income).
Netherlands
Deductible + maximum reimbursement for drugs in list 1A, full reimbursement for drugs in list 1B
and conditional reimbursement (i.e. restricted to certain conditions of use, for specific categories
of patients) for drugs in list 2.
Spain
Co-insurance rate of about 40% of costs, reduced to 10% (and capped to EUR 2.64/pack) for
chronically ill patients. Exemptions exist for some categories of patients (e.g. pensioners and
their dependents, treatments for workplace injuries).
Sweden
Deductible (SEK 900) and then a decreasing co-insurance rate. The participation is capped at
SEK 1,800 per year, beyond which the patient receives a "free card".
United Kingdom Co-payment is GBP 7.65 per prescription, but a number of patients are entitled to free prescriptions (i.e. under 16 and over 60 patients, pregnant women, patients with a specified medical
condition).
Norway
Co-insurance rate of 38%, capped to NOK 520 (EUR 66.40) per prescription. In addition,
patients’ copayments are capped to an annual ceiling of NOK 1,880 (EUR 240).
Australia
Co-payment of AUD 35.40 per prescription, reduced for pensioners and veterans to AUD 5.80.
Canada
Co-payments are specific to each drug plan.
Japan
30% co-insurance rate.
Korea
Co-insurance rates, varying with the level of referral of the facility.
Source: Value in Pharmaceutical Pricing, OECD Health Working Papers No. 63, 2013, p. 70.
Page 1 of 1