Medicinal products

New payment contribution system for purchases of medicinal products, 4 May 2013

A new payment contribution system for purchases of medicinal products entered into force 4 May 2013, in accordance with amendments to an act passed by Althingi 1 June 2012. The main goal of the act is to increase equality between individuals, regardless of diseases, and reduce medicinal costs for those having to use a lot of medicinal products.

More reasonable system — greater equality

A characteristic of the older payment contribution system was that the costs of those continuously using a medicinal product, and even requiring many medicinal products, could become very high because there was no cap for individuals' medicinal costs. Also, the payment contribution from Icelandic Health Insurance (SÍ) varies by the category of medicinal products, which creates inequality between individuals with different diseases.

The benefits of the new system include:

  • Individuals' equality increases.
  • People's high costs due to medicinal products are addressed.
  • The system is simpler than the older system.

Payment contribution steps

The new system builds on payment contribution steps, where each individual pays proportionally less as his or her costs because of medicinal products increase during a 12-month period. In the first step an individual pays the full cost of a medicinal product; in the second step 15% of the cost of medicines and in the third step 7.5%. When the cost of medicines reaches a certain maximum, a doctor can apply to SÍ to fully pay the costs of medicine for the remainder of the period, after specified conditions are fulfilled.

All of the medicines entitled to SÍ's contributions to the payment of (including medicines an individual has gotten approved medicinal product certificates for) will be included in the payment steps. The medicinal products that SÍ does not contribute to paying, fall outside the payment steps.

Those having heavy costs for medicine therefore generally pay less for medicinal products in the new system. Those not needing to purchase medicinal products often will generally pay more than before.

The 12-month payment period starts with an individual's first purchase of a medicinal product. If, for example, an individual first purchases medicine on 15 May 2014, the payment period ends on 15 May 2015. A new period begins when the person involved buys a medicinal product for the first time after the above period is over.

Previously subsidized medicinal products will be included in the system

Medicinal products that have not been paid for in the older system are those marked by an asterisk in the medicinal product price list, e.g., medicinal products for glaucoma and diabetes. Also individuals having Parkinson's, epilepsy and Sjogren's syndrome did not pay for their medicinal products if they were issued medicinal product certificates. These medicines and individuals participating in the cost of them will be included in the system.

Medicinal products' cost calculated by Medicinal Products Calculator

A Medicinal Products Calculator has been added to SÍ's website. The calculator enables you to calculate the cost of medicinal products, based on given premises. Those curious to see how the cost of medicinal products accumulates in the new system are encouraged to acquaint themselves with the calculator.

Check the status of medicinal product purchases in the Rights Gateway

The Rights Gateway — My Pages shows you a summary of your medicinal product purchases and step status. Login requires electronic ID or a password from tax authorities. After login click on "My Rights Status" and then "Medicinal products purchases - step status".

Payment steps — medicinal product purchases

Amounts in payments steps and an example of medicinal product purchases can be seen in the tables below.  People, aged 67 and older, disability pensioners, children and youths younger than 22 pay lower amounts than others. All children in the same family, who are under the age of 18, pay as one.


Payment contribution in general

Steps                Medicinal product costs over 12‑month period  Payment percentage
Individuals Total coast Individuals Health Insurance
1 ISK 22,000 ISK 22,000 100% 0%
2 ISK 31,750 ISK 87,000 15% 85%
3 ISK 62,000 ISK 490,333 7.5% 92.5%
Total ISK 0 ISK > 490,333    


People, aged 67 and older, disability pensioners, children and youths younger than 22.

Steps             Medicinal product costs over a 12-month period Payment percentage
Individuals Total coast Individuals Health Insurance
1 ISK 14,500 ISK 0 100% 0%
2 ISK 20,875 ISK 57,000 15% 85%
3 ISK 41,000 ISK 325,333 7.5% 92.5%
Total ISK 0 ISK > 325,333    

Medicinal Products Calculator

      medicinal-products-calculator

With the Medicinal Products Calculator you can calculate estimated medicinal product costs in the new payment contribution system, based on the premises entered.

The cost of medicinal products for individuals in the new payment contribution system is based on their step status for each 12-month period, and then it is important how much individuals have paid for medicinal products during the period before medicinal product purchases occur.

In order for the calculator to compute accurately, the previously paid cost of medicinal products is recorded as well as the total cost of the next purchase of medicinal products.

Click here to use the calculator. (Opens in a new browser window)


Prices of medicinal products

The Medicinal Product Payment Committee determines the prices of medicinal products in accordance with the medicinal product price list below, which is issued each month. If a medicinal product is registered with a zero (0) under the category "Paymt. code" Icelandic Health Insurance (SÍ) does not pay for the medicinal product, and it therefore falls outside the payment steps in the new system. SÍ makes payment contributions for all other medicinal products, which come under a payment step in the new payment contribution system.

SÍ's payment contribution is based on the reference price of the medicinal product, if it is available (see column farthest right in the price list). A reference price is the lowest maximum price of generic medicinal products. If a reference price is lower than the price of a medicinal product, the individual pays the difference. That price does not fall under a payment step in the new system.


Medicinal product certificates

Medicinal product certificates increase payment contributions from Icelandic Health Insurance (SÍ) for medicinal product costs exceeding general rules. A doctor applies for a medicinal product certificate for an individual that is issued upon the fulfilment of certain conditions in accordance with the work rules specified below.

Medicinal product certificates and the new payment contribution system for purchase of medicinal products

The rules on issuing medicinal product certificates will change  in the new payment contribution system. Medicinal product certificates that have been issued and are in force will remain in force throughout their validity period, but the rights to payment contributions will change.

Until 4 May 2013 medical certificates confirm or increase SÍ's payment contributions variously, depending on the medicinal product category. After 4 May SÍ's payment contribution is simplified as follows: medicinal products are either eligible for payment contribution (G-code) regardless of medicinal product category, or they are not eligible for payment contribution (0-code). Medicinal products eligible for payment contribution fall under the new payment steps. In the new system medicinal product certificates will, on one hand, confirm rights to payment contributions to medicinal products not eligible for payment contribution (0-code) and, on the other hand, grant full payment contribution after individuals have paid a maximum amount in accordance with the above payment steps. In all instances a doctor applies to SÍ for medicinal product certificates.

An exception to this is that a medicinal product certificate will be issued for a 100% payment contribution from Health Insurance when alleviate nursing treatment at home in the final steps of kidney failure or serious psychosis is involved.

Medicinal product certificates are issued in accordance with the work rules specified below.

See which medicinal products receive payment contributions.

Medicinal product certificates are electronic

Medicinal product certificates are electronic, and pharmacies receive confirmation from SÍ of the rights granted by medicinal product certificates for the purchase of medicinal products.

The status of medicinal product certificates can be checked in the Rights Gateway (individuals' My Pages) (Opens in a new browser window), which publishes, for example, information on approved certificates, such as the period of validity and names of medicinal products. We urge those expecting medicinal product certificates to enter their e-mail addresses in the Gateway under "My Settings" because SÍ will send notices to registered e-mails when a decision has been made.


Remedies regarding medicinal product payments

Icelandic Health Insurance wishes to point out the remedies specified below regarding medicinal product costs.

Dispensing smaller quantities

In certain instances pharmacies can be requested to sell smaller quantities of medicinal products. For example, pharmacies can dispense one month's quantity at a time, despite a prescription specifying a three-month quantity.

Reimbursement for high expenditures

Individuals, who earn low wages and incur high payments because of medical assistance, medicinal products or training, may have a right to reimbursement for part of the expenses from the State Social Insurance Administration (TR). Reimbursements because of this will increase after 4 May 2013 (see the regulation below). Further information on TR's website. (Opens in a new browser window)

Medicinal product certificates

A doctor can apply for medicinal product certificates, after fulfillment of certain conditions, for medicinal products that are generally not eligible for payment contribution by SÍ. See information on medicinal product certificates.

Payment distribution

Most pharmacists by far have become parties to an agreement on the distribution of medicinal product costs because of payment difficulties. Under the agreement individuals having difficulties paying for medicinal products because of low income or unexpected medicinal product costs can spread out payments. The distribution of costs is at no cost to individuals. See information on payment distribution and a list of pharmacists offering distribution of payments.

 

Examine a summary of medicinal product purchases and step status

The Rights Gateway — My Pages shows you a summary of your medicinal product purchases and step status. Login requires electronic ID or a password from tax authorities. After login click on "My Rights Status" and then "Medicinal products purchases - step status".

 



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