A new amendment to existing legal framework, introducing new patient co-payment limits for medicinal products, medical devices, and dietic foods, has been published on 20 February 2021. The current legislation already contains quarterly co-payment limits for certain categories of patients, such as people with disabilities, pensioners, and children below the age of six. If the patients’ respective co-payment limits, re-calculated to the cheapest generic product, are exceeded, the health insurance companies are obliged to refund the excess amount to the patients.
Effective from 1 April 2021, the co-payment limit for all patients that are, as of the first of day of the respective calendar quarter, below the age of six, will be zero. This group of patients will not be charged any co-payment in the pharmacies, as a result of which the excess amount will no longer have to be refunded to them by the health insurance companies.
Further, from 1 January 2022, zero co-payment limit will also apply to persons whose overall income in the respective calendar quarter does not exceed 180 % from the average monthly income for the calendar year preceding by two years the year when the entitlement to zero co-payment limit is assessed, and, the same time, are disabled, receive disability pension, retirement pension, early retirement pension, or reached the retirement age without being entitled to a pension. The list of persons entitled to zero co-payment limit will be kept by the health insurance companies, and will be available to the pharmacies, who will not charge these patients any co-payments. Patients who will become employed or start a business during the respective calendar quarter will be deleted from the list. The health insurance companies will then re-assess their entitlement to zero co-payment limit, and will be able to claim back the refund of the co-payments they covered in the quarter in which the patient lost the entitlement to zero co-payment limit.
This new measure is expected to cost the public health insurance approx. EUR 37 Million per year in 2021, 2022, and 2023.
For more information, please contact our healthcare and pharmaceutical law specialists Marek Holka (marek.holka@cechova.sk) and Tomáš Rybár (tomas.rybar@cechova.sk).
***
This legal information was prepared in February 2021 exclusively for the purpose of providing general information and should not be viewed as a legal advice. The aforementioned overview is not comprehensive, but only provides a brief summary of the relevant legal regulation. If you have any questions regarding this topic, please do not hesitate to contact us.