Pharmaceuticals

Reimbursement of pharmaceutical products in Denmark depends on the accumulated amount for reimbursable pharmaceutical products purchased by the individual person. There are five reimbursement categories. Reimbursement starts at DKK 1 145 for adults and at DKK 0 for children <18 years. The percentage of reimbursement increases proportionally with the patient's costs. Maximum payment within a 12-month period is DKK 4 435.

Reimbursable pharmaceutical products are products with a documented and valuable therapeutic effect. The price of the pharmaceutical product must be reasonable in relation to its therapeutic value.

For pharmaceutical products that are not subject to a general subsidy an individual subsidy can be granted. This requires an application to the Danish Medicines Agency by one's own general practitioner.

The Danish Medicines Agency determines a reference price for each group of pharmaceutical products covered by the reference price system. The reference price forms the basis for the calculation of the subsidy. The reference price system includes prescription-only products and over the counter products that are allowed for pharmacy-only sales.

The aim of the system is that the pharmacy sells the cheapest product on the market. In special cases, the physician or dentist can mark the prescription thus there will be no substitution.

Pharmaceuticals prescribed by general practitioners (GPs) are subjected to co-insurance whose level depends on the pharmaceuticals cost sustained in a 12-month period (reimbursement year). The National Health Insurance reimburses the costs for pharmaceuticals included in the Health Insurance scheme included in the cost ceiling arrangement.   Pharmacies are obliged to substitute pharmaceuticals with cheaper generic alternatives as stipulated by the reference price system.

For users aged 67 and older, the percentages are the same. However, the maximum payment for this aged group is set at DKK 1 327.70. For users aged 0-18, the user charges are DKK 0.

All pharmaceutical products are distributed through the health service except for certain non-prescription pharmaceutical products. These are available, to a very limited degree, from certain general stores. Non-prescription pharmaceutical products are distributed to a varying degree by district health services. Pharmaceutical products distributed by the health services are free.

There are three payment categories (40, 65 and 100 per cent) for prescription pharmaceutical products, and reimbursement is calculated separately for each purchase after an annual initial deductible of EUR 50.00 for all adults. However, there is a user charge of EUR 4.50 for pharmaceutical products with 100 per cent reimbursement.

The reimbursement amount depends on whether the pharmaceutical product is part of the reference pricing system. Pharmaceutical products are categorized according to the reference pricing system. Products that belong to the same reference pricing group contain equal amounts of the same drug substance and are biologically equivalent, which makes them interchangeable.

Some new and expensive drugs (e.g. for dementia and multiple sclerosis) are paid for by the hospital or municipality in special cases. New drugs are not automatically covered by the reimbursement scheme, and many drugs are marketed without any reimbursement.

In addition to reimbursement for medicines, reimbursement can also be given for special diets for some treatment-intensive diseases and for ointments used in the treatment of chronic skin diseases.

As a main rule, the health insurance scheme reimburses expenditure on prescription pharmaceutical products exceeding EUR 605.13 in the course of one calendar year (excluding user charges of EUR 2.50 per product per purchase).

The subsidy system for pharmaceutical products in Iceland is like the other Scandinavian countries (Denmark, Faroe Islands, Norway, and Sweden). The system builds on payment contribution steps, where the individual pays proportionally less as the costs for pharmaceutical products increase during a 12-month period. The individual pays all expenses for pharmaceutical products up to a certain limit (the subsidy limit). Then his or her payment gradually decreases until annual expenses have reached a maximum amount (the annual limit). After this the expenses are fully covered.

The 12-month payment period starts with an individual's first purchase of a pharmaceutical product. The patient pays the initial ISK 22 000, then 15 per cent of the costs up to ISK 31 750, then 7.5 per cent of the costs up to ISK 62 000. Costs that exceed this amount are fully subsidized. The annual limits for subsidies to pensioners, disabled people, children, and young people under the age of 22 years are lower than for other people. These groups pay the initial ISK 11 000, and their costs are fully subsidized when they have paid ISK 41 000.

All pharmaceutical products authorized by the Health Insurance scheme are included in the payment system. Other pharmaceutical products fall outside the payment system.

Reimbursement according to drugs listed (”blue prescriptions”) will always be reimbursed when prescribed for the diagnoses (indicated by the ICPC and ICD codes) specified in the reimbursement list. The Norwegian Medicines Agency decides which medicines are included in the list and which diagnostic codes/conditions should be subject to reimbursement prescribing. User charges for pharmaceutical products on blue prescription are 39 per cent of the prescription cost, up to a maximum of NOK 520 per prescription or up to a quantity corresponding to 3 months' use. Exemption card for further expenditures is granted at NOK 2 460 (2021).

The Health Economics Administration (HELFO) makes decisions regarding individual reimbursement for drugs not included in the general reimbursement list. Individual reimbursement requires either that the indication for use of the drug is covered by a diagnostic code in the reimbursement list or the drug will be used to treat a rare or serious chronic disease not listed in the reimbursement list. Decisions are made for each patient based on of application from the treating physician.

Drugs used for communicable diseases are fully reimbursed according to a specified disease list. The reimbursement is granted for anti-infectives, immunostimulants and vaccines. This support is provided to all who live in Norway, regardless of citizenship. The regional health authorities (RHAs) provide dedicated funding for certain expensive drugs. This applies to defined drugs used in the treatment of rheumatic disorders, multiple sclerosis, various cancer types, skin diseases, hepatitis C, kidney failure and gastrointestinal diseases.

The maximum individual payment over a twelve month period is 2 350 SEK (2021) and applies to prescribed medications included in the scheme, and some types of consumables. Starting at 1 175 SEK the high-cost scheme reduces patient costs for prescription medicines stepwise, by reducing the prices by 50 per cent, 25 per cent etc. The pharmacies follow-up purchases within the high cost protection scheme. 

Prescription medicines are free for children and youth under the age of 18. Contraceptives are free under the age of 21, and patients with diabetes get insulin free of charge.