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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.

Prescribers ensure that restrictions are followed

Every prescriber is responsible for making sure that the prescription meets the requirements for reimbursement, for example in the case of medicines with restricted reimbursement.

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

Senast uppdaterad 08 november 2017


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