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Levels of payment

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Prices and margins for reimbursed medicines are fixed, prices – the negotiated with producers. Reimbursed medicines have defined levels of payment and the reimbursement limit. In Poland, a few levels of payment have been established. The Minister of Health classifies reimbursed medicines in the relevant group with regard to the guidelines referred in the provisions of the Reimbursement Act.

In the joint-limit group the basis for a limit is the highest among the lowest wholesale prices for a defined daily dose (DDD) of the medicine which completes 15% of the quantitative turnover, calculated according to DDD, achieved in this joint-limit group in the month preceding the announcement of the notice by 3 months. If the retail price is higher than the reimbursement limit basis, a patient covers the difference between the retail price and the reimbursement limit basis.

A medicine is classified to the relevant payment group based on the calculations that assume using one defined daily dose (DDD) on a daily basis. If DDD is not defined, the medicine is classified based on the monthly therapy’s cost.

DDD is a unit determined by the World Health Organization (WHO). However, not always it reflects a recommended dose of a medicine. For more information about DDD please visit: www.whocc.no/atcddd

Medicines dispensed free of charge up to the limit – this group includes medicines and medical devices whose effectiveness at treatment of a malignancy, a psychosomatic disorder, a mental retardation or a development disorder or an infectious disease of a special epidemiological threat for the population has been proved.

If the price of the medicine is equal to the reimbursement limit or lower than it, a patient will receive this medicine free of charge. However, if the retail price of the medicine is higher than the reimbursement limit, a patient will pay the difference between the retail price and the reimbursement limit.

For example:

No 1
the retail price of the medicine: 100 PLN
the reimbursement limit: 100 PLN
the amount to be paid at the pharmacy: 0 PLN

No 2
the retail price of the medicine: 100 PLN
the reimbursement limit: 80 PLN
the amount to be paid at the pharmacy: 20 PLN

Medicines dispensed against a lump sum payment up to the limit – this group includes medicines, foods for special medical purposes and medical devices:

  • that require – according to the current medical expertise – using for more than 30 days and the monthly cost of their use for a patient with payment of 30% of the reimbursement limit would exceed 5% of the minimum wage;
  • that require – according to the current medical expertise – using for more than 30 days and the cost of their use for a patient with payment of 50 % of the reimbursement limit would exceed 30% of the minimum wage;
  • medicines that before the date of entry into force of the Reimbursement Act were dispensed against the lump sum payment providing that – according to the current medical expertise – they are used for more than 30 days.

If the price of the medicine is equal to the reimbursement limit or lower than it, a patient will receive the medicine against payment of 3.20 PLN per pack containing not more than 30 DDD ( defined daily dose according to WHO) or the amount proportionally higher in case of the packs containing over 30 DDD. However, if the retail price is higher than the reimbursement limit, a patient will pay a lump sum with regard to the number of DDD in the pack ( in case of the packs containing up to 30 DDD, it will amount 3.20 PLN) and the difference between the retail price of the medicine and the reimbursement limit.

If the retail price of the medicine is lower than the lump sum (3.20 PLN), the payment of the patient is equal to the medicine’s retail price.

For example:
the retail price of the medicine containing 30 DDD in the pack: 100 PLN
the reimbursement limit: 80 PLN
the amount to be paid at the pharmacy: 3.20 PLN + 20 PLN = 23.20 PLN.

Medicines dispensed against the payment of 50% up to the reimbursement limit – this group includes medicines, foods for special medical purposes and medical devices which – according to the current medical expertise – require using not longer than 30 days.

If the price of the medicine is equal to the reimbursement limit or lower than it, a patient will receive this medicine paying half of the medicine’s retail price. However, if the retail price of the medicine is higher than the reimbursement limit, the patient will add to the amount mentioned above the difference between the retail price of the medicine and the reimbursement limit.

For example:
the retail price of the medicine: 100 PLN
the reimbursement limit: 80 PLN
the amount to be paid at the pharmacy: 80 PLN * 50% + 20 PLN = 60 PLN

Medicines dispensed against the payment of 30% up to the reimbursement limit – this group includes medicines, foods for special medical purposes and medical devices which haven’t been classified to the payment groups mentioned above.

If the price of the medicine is equal to the reimbursement limit or lower than it, a patient will receive this medicine paying 30% of the medicine’s retail price. However, if the retail price of the medicine is higher than the reimbursement limit, the patient will add to the amount mentioned above the difference between the retail price of the medicine and the reimbursement limit.

For example:
the retail price of a medicine: 100 PLN
the reimbursement limit: 80 PLN
the amount to be paid at the pharmacy: 80 PLN * 30% + 20 PLN = 44 PLN

Ministry of Health

The Ministry of Health is an office of government administration serving the Minister of Health.

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