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12-03-2025

Answered the most common question about medicine co-payments: why does my neighbour pay less?

Iliustracija

Every patient in Lithuania, who is prescribed reimbursed medicines, faces co-payments – the amount he/she has to pay. Thanks to the occurrence of additional reimbursement mechanisms, patients’ co-payments for reimbursed medicines are decreasing year by year. It is estimated that total patients’ co-payments have decreased almost two times over the last decade. But there are still questions about why some people pay more for reimbursed medicines than others and what to do if you want to save money at the pharmacy?

Co-payments may differ

Imagine that two neighbours with prescriptions for medicines with the same active ingredient can walk out of the pharmacy having paid different amounts. The question that usually arises is: “Why did I pay more than my neighbour?” Lina Škiudaitė, Adviser to the Pharmaceuticals Reimbursement Division of the NHIF, explains that this happens because the state reimburses the biggest part of the price of the medicine – the rest is paid by patients, and for some of them, a co-payment may be covered by the state.

A co-payment of a medicine is the difference between its selling price at the pharmacy and the reimbursement price – so the amount of a co-payment of a medicine is determined by the manufacturer’s price for Lithuania.

“The compensatory price is set by taking the average of the lowest prices in several other European Union (EU) countries. Markups and value-added tax are added to the manufacturer’s price for Lithuania. If it is significantly higher for Lithuania than the average for European countries, a co-payment increases. Lithuania aims to pay the same price for medicines as other EU countries on average,” L. Škiudaitė says.

A co-payment is less than 6 euros 

A patient’s co-payment for a pack of medicines at the pharmacy should not exceed EUR 5.87. However, if compensatory price of the medicine is low, e.g. EUR 3, then, the co-payment should not exceed 20% of the compensatory price. Compare: in Austria, the fixed co-payment is set at EUR 7.55 per pack.

“Of course, there are exceptions, when co-payments can be higher, but these are very rare, single cases. For example, when the list of reimbursable medicines was being drawn up, it happened that all the medicines of a certain active substance exceeded the expected co-payment. In this case, an exception is made and at least one medicine with a certain dosage of that active ingredient is included in the price list so that patients have the opportunity to receive it as a reimbursable medicine”, the Adviser of the Pharmaceuticals Reimbursement Division of the NHIF says.

The specialist also notes that over the last decade, the co-payments for medicines have fallen significantly. In 2016, patients in Lithuania paid around EUR 58 million for medicines, and by 2024 this amount almost halved to EUR 26 million.

“The amount reimbursed by the state for medicines and medical aids has tripled from over EUR 200 million in 2016 to almost EUR 600 million last year. In addition, the list of reimbursable medicines has expanded, with new medicines for oncological diseases, migraine and other serious illnesses. As these medicines are expensive, the state covers most of the cost, thus reducing patients’ expenses,” L. Škiudaitė says.

Innovations help you save

In 2020, Lithuania introduced the first reimbursement measure to reduce patients’ co-payments, targeting socially vulnerable groups. It is aimed at patients over 75 years old, people with disabilities or at retirement age, and those with low insurable income – up to EUR 450 a month this year. 

“For people in this group, absolutely all co-payments are covered: both for medicines and medical aids. So, for an 80-year-old patient who has been prescribed five different medicines and a glucose monitor by his doctor, everything, including both the reimbursement price and the patient’s co-payment, will be covered by the state,” L. Škiudaitė explains the example.

It is estimated that in the first half of the year alone, this reimbursement measure helped patients save around EUR 7 million, which was covered by the state budget.

In 2023, another new reimbursement mechanism, the so-called co-payment basket, was introduced based on the experience of foreign countries. A similar system is in Sweden, where a patient pays a co-payment for part of the year out of his own pocket, and then stops paying the co-payment once he reaches a certain amount. However, in Sweden, this threshold is significantly higher than in Lithuania – around EUR 250. In Lithuania, current amount of the co-payment basket is EUR 59.04.

“This system is particularly useful for patients with chronic diseases who take a wide range of reimbursable medicines every month. It is also focused on patients’ awareness, because in order to benefit from it, the citizens themselves must be interested in choosing the medicine with the lowest possible co-payment. If you have doubts about whether there are enough of them, look at the figures: there are around 1,500 medicines with the lowest co-payment in Lithuania, out of the 2 000 on the list. When a person goes to a pharmacy and asks for a pharmacist’s recommendation, medicines with the lowest co-payment should be offered first and displayed on the screen. And if a patient pays EUR 59 and 4 cents for insulin, for example, from his/her own funds, by the end of the year, he/she will no longer have to pay co-payments, which will be covered by the state,” L. Škiudaitė says.

A convenient way to check how many co-payments are already in your basket is to check your personal E. sveikata account or ask at the pharmacy.

This article is a part of the pharmacy literacy campaign “Medicines don’t speak”, run by the NHIF. 

The NHIF invites you:

Last updated: 31-03-2025

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