Types of reimbursement

There are two main types of reimbursement status for which a medicine may be eligible: general or restricted.

General reimbursement

General reimbursement means that a medicine is eligible for reimbursement for its entire approved area of use.

Restrictions and special conditions

We sometimes restrict the reimbursement for a medicine to be included in the pharmaceutical benefits scheme only for a certain area of use or a specific patient group. These medicines are granted a so-called "restricted reimbursement." We may also stipulate special conditions for a reimbursement decision. Such a condition might be that the applicant after some time should present new data on the use of the medicine in the health care system or that a restriction of the reimbursement should be declared in the marketing of the medicine.

Reasons for restricted reimbursement

There are several reasons why a medicine might be granted restricted reimbursement. One such example is that a medicine is only cost-effective for one limited and specific group of patients.

Or, while a medicine may have several areas of use, its use may only be cost-effective only for one of these areas.

A further reason may be that some patients may lack treatment options because they are unable to take a certain medicine or a certain dosage form.

Follow the link to the right to our database to find information about which medicines are subject to restricted reimbursement.