Modest growth in medicines reimbursements in 2014

Last year, the medicines reimbursements paid by the Social Insurance Institution KELA totalled 1.3 billion euro, 2.6 percent up from the preceding year.

Kela pays the medicines reimbursements on medicines, clinical food preparations and basic creams. The patient is entitled to medicines reimbursement provided by society if a prescription has been issued by a physician, i.e., the medicine is to be used for the treatment of a disease, and it is included in the reimbursement system.

The medicines reimbursements are divided in three categories. The bulk of the reimbursements paid by KELA in 2014 were those for the medicines in the upper special reimbursement category, or 621 million euro. This category includes the medicines for diabetes, epilepsy and various cancers. Each time the patient buys medicines included in the upper special reimbursement category, they pay the three euro patient co-payment while Kela covers the rest of the expenses.

Last year’s reimbursements for the medicines in the lower special reimbursement category totalled 235 million euro. Kela’s share of these medicines is 65%. The lower special reimbursement category includes medicinal products such as asthma medicines and antirheumatics as well as those for the treatment of cardiovascular diseases.

The basic reimbursement rate is 35% of the medicine price, and Kela’s payments in this category totalled 299 million in 2014. The medicines entitling to basic reimbursement include antibiotics, analgesics and allergy medicines, for example.

In addition to the above, Kela paid out 152 million euro in additional reimbursements to patients who use many medicines. As a result of the changes made in the medicines reimbursement system in 2014, a growing number of those who use many medicines will start to receive them completely free in the latter part of the year which will increase the total amount of supplementary reimbursements.

Government has set an annual ceiling for patients’ medicines costs, which was 610 euro last year. Once the patient’s medicines expenses exceed this limit, Kela will reimburse all medicine prices in excess of the 1.5 euro patient co-payment.

“We find that targeting the medicines reimbursements to those who use many medicines is the first step in the right direction”, Sirpa Rinta, PIF’s Director of Pharmaceutical Policy comments on the change.

“Next year, a new 45-euro initial patient co-payment will be introduced and applied to all over 18-year-olds. At the same time, the basic reimbursement rate increases to 40% but the patient-specific ceiling of medicines costs remains unchanged, except for the index adjustments. As a consequence, the reimbursements will be increasingly allocated to those who use many medicines”, Rinta adds.

Further information:

Sirpa Rinta, Director of Pharmaceutical Policy, Pharma Industry Finland PIF

Tel: +358 40 533 0666

25. Feb 2015