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Pharmaceutical

To receive payment of their medical expenses, the insured, member or beneficiary must satisfy the basic eligibility conditions stipulated by the health insurance

Definition

This refers to all products dispensed by pharmacies: medication and hygiene, nutritional, dietary and disinfection products.

Reimbursement

To be reimbursed, medications must:

  • be prescribed by a practitioner in accordance with the therapeutic indications stipulated,
  • appear on the list of reimbursable medications.

Certain products can be prescribed in the form of preparations produced by the dispensing pharmacies; in this case reimbursement is subject to the advice of the fund's Medical Advisor.

Not all products, even if they have been prescribed, are eligible for reimbursement.

As a general rule, the insured is required to pay the costs up front.

For reimbursement, present the original prescription along with a medical expenses claim form upon which the dispensing pharmacist has entered the itemised invoice.

Reimbursement is based on the sales price of the products, or if there is one, the sales price of the generic medication.

As with other benefits, the patient contribution rate is set at 20%.

Practical advice

When it comes to repeat prescriptions, reimbursement requests must be accompanied by a photocopy of the prescription, with a note of each repeat made, except the final purchase to which the original prescription must be attached; this must also be presented to the pharmacist every time the medications are dispensed.

Unless you are going abroad, you must limit your purchase to the quantity needed for one month of treatment.

In order to avoid a reduced reimbursement rate, ask your pharmacist whether there is a generic medication; if so, he can substitute this for the prescribed medication unless the doctor specifies on the prescription that they are opposed to this substitution.