What do medicines cost on prescription?
Vad kostar läkemedel på recept?

What applies?

What applies?

High-cost protection

The state subsidises, i.e. provides financial support, when you need medicines and some other products you may need if you have certain diseases. Most medicines that are prescribed are subsidised. The subsidy is described in the Act on Pharmaceutical Benefits. The high-cost protection provided by the law is known in everyday speech as the “high-cost ceiling”.

According to the law:

  • you receive a discount according to an incremental system for most medicines, contraceptives and stoma care products
  • you do not pay anything at all for certain medicines, for example insulin, or for disposable items that are needed to administer medicines to your body and to check your medication, for example lancets for measuring your blood sugar
  • you receive certain protection from high costs for certain foodstuffs for children under the age of 16.

Price and subsidy

The Dental and Pharmaceutical Benefits Agency, TLV, is the agency that decides prices and subsidies. When the TLV makes a decision on a subsidy it looks at whether the medicine’s usefulness corresponds to to the cost of subsidising it. Examples of usefulness include better health and increased life expectancy. The TLV also assesses whether use of the medicine can reduce society’s costs, for example for operations, sick leave or care of the elderly.

The pharmaceutical companies can choose to sell a medicine outside the high-cost ceiling system. Then the pharmaceutical companies are free to set the price themselves. You must pay the entire cost for medicines that are not part of the high-cost ceiling system.

Some medicines may have a limited subsidy. This means that the medicine is only subsidised for a certain group of patients or to treat a certain disease.

The FLV and FASS have websites where you can see if a medicine is subsidised or not.

Cheapest equivalent alternative

Sometimes there are several equivalent alternatives of the same medicine available. These are called generics. They contain the same amount of the same active substance or substances and have the same effect. But they may look different and contain different additives, like preservative for example. They may be from different pharmaceutical companies and have different prices. These alternatives can be substituted for each other at pharmacies. It is the Medical Products Agency that decides which medicines are interchangeable with another medicine.

If there are several generic medicines and the one on the prescription is not the cheapest one, the pharmacies must change it to the alternative that has the lowest price on the market. Only the cheapest alternative is fully subsidised. You can choose to buy the more expensive medicine stated on the prescription, but then you must pay the difference yourself, it is not included in the high-cost ceiling system. If you do not want the alternative that the pharmacies change to or the one on the prescription, you can choose another generic alternative. But then you must pay the entire cost yourself. Only the medicine on the prescription and the cheapest equivalent medicine are included in the subsidy. The reason for this is that no-one should have to pay more than necessary for a medicine if there are equivalent alternatives for different prices available.

If you must use a specific brand of medicine for medical reasons the doctor can state on the prescription that it must not be substituted. Then you do not have to pay the extra cost, providing that the medicine is included in the high-cost ceiling system. Examples of medical reasons could be that you are allergic to a colourant in a tablet or that you find it hard to open certain packaging.

Product for the period

Each month the TLV sets the prices after the pharmaceutical companies have applied for price changes. For generic medicines the alternative that has the lowest price is called the “product for the period”. The TLV tells the pharmacies which alternative is the product for the period and that the pharmacies must change to it. The TLV also decides on two backup alternatives to change to if the product for the period is out of stock. This means that the alternatives that pharmacies change to can vary from one month to the next.

The purpose of the product for the period is to ensure that the tax funds reserved for medicine subsidies cover as much medicines and as many people as possible.

The product for the period is the same at all pharmacies, but sometimes a pharmacy may have purchased too much of the product for the period. The pharmacy is then allowed to sell it during the following month as well. This means that you may be offered last month’s product at one pharmacy and the current month’s product at another pharmacy. These two products may have different prices.

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High-cost ceiling system

High-cost ceiling system

You pay a maximum of 2,200 SEK per year

The high-cost ceiling system means that you pay a maximum of 2,200 SEK per year. This year is called a high-cost period.

From 1 January 2012 new rules came into force for the amounts in the high-cost ceiling system. The highest total you pay was changed from its previous amount of 1,800 SEK. If have you started a high-cost period before the turn of the year, the new rules only start to apply when the current twelve-month period has ended.

The high-cost ceiling system applies for medicines that you are prescribed and that the TLV have decided will be subsidised. This also applies to consumables that you get on what is known as a “aid card”.

For most medicines you pay what is known as a “copayment” every time you buy prescribed medicines until you reach 2,200 SEK. The same applies for consumables for stoma care.

For some medicines you do not pay a copayment. If you have insulin-treated diabetes you do not need to pay for the insulin. If you have a disease that comes under the Communicable Diseases Act, the county council will pay the entire cost of medicines that reduce the contagiousness, for example HIV antivirals.

Each county council pays all or part of the copayment for certain medicines and certain patient groups, for example contraceptive pills for young women.

You do not pay anything at all for consumables that are needed to administer medicines to your body and to check your medication. Examples of this kind of consumables are needles and lancets used to measure blood sugar levels.

Copayment according to the incremental high-cost system

From 2012, when you start a high-cost period of a year you pay the entire cost of medicines and stoma care products yourself until you have paid a total of 1,100 SEK. Then the amount you pay yourself is reduced according to an incremental system. When you have paid 2,200 SEK you do not have to pay any more for the rest of the year, calculated from the day the you started the high-cost period. In order for this to apply, the medicines you collect must be part of the high-cost ceiling system. When the high-cost period ends you start again with your next purchase, no matter where you are in the incremental system.

How the incremental system works

Total medicine cost

       

Highest amount you pay

5,400

       

2,200

3,900

     

90% discount

2,050

2,100

   

75% discount

1,600

1,100

 

50% discount

1,100

 

0% discount

 

The table shows how much of the cost you pay yourself, depending on the price of the medicine if you start a high-cost period after 1 January 2012. For each new purchase you start from the cost you had reached with your previous purchase and climb up the “staircase”.

Special food for children

Foodstuffs for children under the age of 16 who have certain diseases, for example gluten intolerance, are subsidised. The foodstuffs are written out on what is called a “foodstuff order” and you can collect supplies for a maximum of 90 days at a time. You pay a fee of 120 SEK yourself each time, but this fee is not included in the high-cost ceiling system.

How much can you buy on each occasion?

You cannot buy unlimited amounts under the high-cost ceiling system. The amount you can buy should be intended to last up to 90 days, i.e. about three months. Contraceptives, e.g. contraceptive pills and injections, are excepted from this three month rule.

If the prescription is valid for several dispensations, a new dispensation can only take place after 2/3 of the time that the previous dispensation covered has passed. For example, if you have collected medicines for three months’ usage, two months must have passed before you can collect medicines again using the prescription.

You are allowed to buy a larger amount than one dispensation in one go, but then you must pay the full price for the amount that exceeds three months’ supply. If the doctor has written on the prescription that there must be a certain period between dispensations, you cannot collect medicines more often than the doctor has stated.

If you have special reasons, for example that you are going to be abroad for a long period of time, you can collect medicines under the high-cost ceiling system for a longer period than three months. But then you must be able to provide proof, for example travel documents.

When does the high-cost ceiling system apply?

In order for the high-cost ceiling to apply, the person prescribing the medicine must indicate this on the prescription. The person prescribing the medicine must also have their workplace indicated on the prescription in the form of a legible barcode.

The high-cost ceiling system covers people who are resident or employed in Sweden, or who have a European Health Insurance Card from another EES country or Switzerland. The European Health Insurance Card must be displayed both when visiting the doctor and at the pharmacy. Sweden also has agreements with certain countries outside Europe; Algeria, Australia and the state of Quebec in Canada, which means that the medicine benefit system applies to citizens of these countries if they need medicines when they are in Sweden.

All children under the age of 18 in the same household, i.e. registered at the same home address, count towards a common high-cost account. This means that all of the children’s copayments are added together. This means that biological siblings who are registered at different addresses have separate high-cost protection.

High-cost database

You do not need to keep track of how much you have paid. In the high-cost database, which is managed by the state-owned company Apotekens Service AB, all purchases within the high-cost ceiling system are registered. The system keeps track of how much you have paid yourself in copayments and works out your discount according to the incremental system every time you purchase medicines. All pharmacies are connected to the same database so it does not matter which pharmacy you go to.

Joining the high-cost database is voluntary. The database registers your name, social security number, purchase date, which pharmacy dispensed your prescription, how much you have paid, the amount you have reached in the high-cost ceiling system and the start date for the high-cost period. The information that is registered is only used to ensure you receive the correct discount. No information on which medicines you have received or which doctors have prescribed them is registered.

At any time you can request an extract from the high-cost database of the information about you and the children you are legal guardian of. You can do so by filling out and sending in a form to eHälsomyndigheten.

Choose to not take part

You can choose to not take part in the high-cost database. Then you will receive a receipt called a high-cost certificate from the pharmacy where you buy medicines included in the high-cost ceiling system. The high-cost certificate states the total copayment sum that you have paid yourself. It is important to save your most recent high-cost certificate and show it along with the prescription when you buy medicines. The pharmacy needs to know which level of the incremental system you are at in order to give you the correct discount.

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Publicerad:
2012-04-18
Skribent:

Written by: 

Åsa Schelin, 1177 Vårdguiden

Granskare:

Reviewed by: Yvonne Borg, pharmacist, Apotekens Service AB