Prescription Payments – Doubts and How to Solve Problems

cost-spain-medicineIn July 2012 co-payment for prescription medicines came into force in Spain and over 18 months later there is still confusion over who is entitled to free prescriptions and, if not, what rate should be paid. Our guide will help to solve your questions.

Who Can Get Free Prescriptions?

There are a limited number of people who are entitled to 100% free prescriptions including:

  • Those who receive the “renta de integración social” (people with no other income).
  • Disabled people (depending on level of disability)
  • People receiving treatment after being involved in a road traffic accident or those that have work-related diseases.
  • Unemployed people who do not receive unemployment benefit. (Note that those receiving unemployment benefit pay the same as salaried workers – see below).

What About Pensioners?

The only pensioners to receive free prescriptions are those receiving a non-contributory pension. Other pensioners will have to pay 10% of the price of medicines with maximum payments in 2014 as follows:

  • Pension below 18,000€/year, maximum payment 8.26€/month
  • Pension between 18,000€ and 100,000€, maximum 18.59€/month
  • Pension over 100,000€, maximum 62€/month (this group pays 60% of the price).

What Do Salaried Workers Pay?

Workers who receive a salary in Spain will pay a percentage of the price of medicines in accordance with their yearly income as shown below:

  • Salary below 18,000€/year – pay 40% of price of medicines
  • Salary between 18,000€ and 100,000€ – pay 50%
  • Salary over 100,000€ – pay 60%

The salary information is contained in your annual tax return, so if your circumstances change it may take some time before your details are forwarded to the Provincial Social Security office.

Are All Medicines Covered By Co-Payment?

The short answer is no.  See this full list of medicines not covered – for these you’ll have to pay full price (list in in Spanish).

I Don’t Agree With The Percentage I’m Asked To Pay – What Can I Do?

The code shown on the prescription is contained in your Tarjeta Sanitaria (Health Card). The chemist has to charge you in accordance with the code, so if you think it’s not correct you’ll have to go back to your clinic to get it changed.

One of the main problems occurs when you have the code DES, this is for desconocido (unknown) and means you’ll automatically by charged 40% of the price of the medicines you need.

If once you’ve been able to check the data held at your local clinic regarding your personal circumstances and income and you still don’t agree, then you’ll need to ask for the “Formulario de Comunicación de Discrepancias”. This is a claim form that will be sent by your clinic to the Provincial Social Security office to be checked. Once they have done this you will be notified in writing, unfortunately there is no established period for this to be carried out.

If you’ve paid more than you should have for your prescriptions, once again you’ll have to make a claim with a form from your local clinic. Remember to always keep copies of prescriptions and the receipts from the chemist in case you need to make a claim.

Good News?

Recently the Spanish Government, due to the public outcry, abandoned the proposal that patients pay part of the cost of non-urgent transport by ambulance. This type of measure would have been particularly important for people with chronic diseases who would have been charged 5€ per ambulance ride.