Principles of reimbursement---
The Minister of Health aims at ensuring to the society an access to medicinal products which are effective, safe and available on the Polish market while reducing the costs of medical treatment borne by patients at the same time. One of the instruments that determine the medicines policy of the state is reimbursement – a patient is able to purchase medicinal products (medicines, foods for special medical purposes and medical devices) whose full or partial cost is covered by the National Health Fund on the basis of the list of reimbursed medicines, foods for special medical purposes – and medical devices prepared by the Ministry of Health.
While preparing the list, the therapeutic value of the medicine, the safe use of it as well as the cost of the therapy is taken into account. The priority in including on the lists should have medicines which guarantee high therapeutic effect at the lowest cost. Updating the list every two months enables efficient adding new products whose effectiveness has been proved and generic medicines – equivalents to the original medicines containing the same active substance.
The following medicinal products are eligible for reimbursement:
- medicines, foods for special medical purposes and medical devices available in a pharmacy based on a prescription in the whole range of registered indications and applications or in the indication determined by clinical conditions;
- magistral medicines prepared from pharmaceutical raw materials or ready-prepared medicines ( for which the administration decision of reimbursement has been made) on condition that the medicine’s dose is smaller than the smallest dose of the ready- prepared medicines in a solid form administered orally;
- medicines which are not authorized for marketing in Poland, imported from abroad within direct import;
- foods for special medical purposes for which the notification hasn’t been submitted and which haven’t been placed on the Polish market e.g. infant formulae.
A product can be reimbursed if:
- is authorized for marketing or remains on the market;
- is available on the market;
- has the EAN identification code (EAN – European Article Number) or other unique code (an equivalent of the EAN code) which allow to distinguish the reimbursed product from different products.
The following groups have right to get reimbursed medicines, foods for special medical purposes and medical devices dispensed (free of charge or against partial payment) on the basis of prescriptions issued by health insurance physicians:
- insured persons;
- persons other than the insured ones having Polish citizenship who live in Poland and meet the income criterion;
- persons having Polish citizenship who are under 18 or persons living in Poland who are pregnant, during delivery or postpartum period.
Persons who are not Polish citizens take use of health services according to the principles defined in separate regulations and international agreements.
A patient may obtain reimbursed products in a pharmacy which concluded with the National Health Fund a contract for dispensing prescription for reimbursed medicines, foods for special medical purposes and medical devices.
The medicines being a part of an emergency care or hospitalization are free of charge for the patient.