Prescription Fee - Prescription Fee Exemption

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Prescription fee: This is how drug costs are covered

Patients receive prescription drugs with a valid health insurance prescription and against payment of the prescription fee in the pharmacy. In this case, the remaining costs of the medication - that is, the costs beyond the prescription fee - are covered by the health insurance.

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Contract doctors can select medication from the Reimbursement Code (EKO) when prescribing. This is published by the umbrella organization of the Austrian social insurance. In exceptional cases, the health insurance company can also reimburse the cost of medication that is not included in the EKO. For this, an application by the doctor to the chief medical service of the health insurance company is necessary.

Requirements for the assumption of costs

Statutory health insurance prescription : The medication was prescribed by a resident doctor with a statutory health insurance contract on a statutory health insurance prescription. In general, POS prescriptions are valid for one month from the date of issue.

If a medication is prescribed by a resident elective doctor or after an inpatient stay in a hospital, this prescription (private prescription) for the reimbursement of costs must be converted to a health insurance provider by the responsible health insurance provider if the elective doctor Hospital do not have prescription rights.

Freely prescribable or subject to approval: most medications can be freely prescribed by the doctor. In all other cases, a head physician's approval of the prescription from the health insurance company is necessary for the assumption of costs.

Note Since the introduction of the "new head physician obligation" (Medicines Approval and Control Ordinance) on January 1, 2005, it is no longer necessary for the insured person to take care of the approval of medication requiring head physician himself. It is up to the doctor to obtain the necessary authorization from the relevant health insurance company. With the help of the drug approval service (ABS), your doctor can process the approval electronically within a few minutes.

Prescription fee

When the medication is dispensed in the pharmacy, the patient has to pay a prescription fee for each prescribed medication pack if the price of the medication is higher than the prescription fee. The prescription fee is a deductible that a patient has to pay for a drug. The pharmacy collects the fee for the health insurance company. The prescription fee in 2019 is 6.10 euros. If the cost of the prescribed medication is less than the prescription fee, only this has to be paid.

You can find more information about the prescription fee on the Social Security website.

Prescription fee exemption

An exemption from prescription fees is possible under certain conditions, including due to a special need for protection, with or without an application.

Prescription fee exemption without application: People are exempt from the prescription fee without application if they belong to the following groups of people:

• Pensioners entitled to a compensation allowance or
• Recipients of a supplementary allowance for a pension or pension benefit under the Pension Act 1965,
• Patients with notifiable communicable diseases (however, the exemption only applies to medication related to this disease),
• Civil servants and their relatives and
• Asylum seekers in federal care.

Prescription fee exemption on application: The prescription fee exemption is granted on application if the net income of all people living in the house community does not exceed certain reference rates. When granting the prescription fee exemption, a high need for medication - for example in people with chronic diseases - is also taken into account.

The net income of people who receive twelve payments per year - this includes, for example, the receipt of unemployment benefits, emergency assistance or pension advances - is converted to 14 payments when applying for a prescription fee exemption ("aliquoted"): net income x 12/14.

You can find more information about the prescription fee exemption on the social security website.

Prescription fee cap

Since January 1, 2008, each insured person only has to pay the prescription fee until he / she has achieved a contribution of two percent of his / her annual net income with these payments in the current year. Thereafter, the prescription fee is automatically exempted.

For each insured person, the social security system keeps an account for the prescription fees paid. These are compared with the net income. As soon as the added prescription fees paid reach two percent of the annual net income in a calendar year, an exemption applies for the rest of the calendar year without an application. As soon as this exemption has been calculated in the system, it is displayed to the doctor via the e-card system when a prescription is issued. The doctor notes the exemption on the prescription, the insured person no longer has to pay a prescription fee in the pharmacy.

For more information on the prescription fee cap, see the Social Security website.