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11-02-2025

Don’t overpay for reimbursed medicines: simple steps to lower costs

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Pharmacies that have contracts with the health insurance funds should ensure that certain essential reimbursable medicines are always available to patients. The National Health Insurance Fund ensures that these medicines are available at the lowest co-payment or at no cost at all. Irma Medžiaušaitė, Senior Adviser of the Pharmaceuticals Reimbursement Division of the NHIF, explains how to make use of these opportunities to ensure that treatment with medicines is not only effective but also affordable.

Which medicines are essential in a pharmacy?

Pharmacies are obliged to have reimbursable medicines from the list approved by the NHIF. This list is based on the medicines most commonly used by patients and it is updated every six months. “The list of reimbursable medicines that pharmacies must have includes medicines for the most common health conditions: blood pressure reducers, pain relievers, heart medications, as well as some antibiotics, medications against diabetes, asthma, hypertension, and other medicines commonly prescribed by doctors for patients,” I. Medžiaušaitė, Senior Advisor to the Pharmaceuticals Reimbursement Division of the NHIF, explains.

The list excludes certain groups of medicines, such as narcotic drugs, which are sold by a limited number of pharmacies with proper conditions to stock them. It also excludes medicines for the treatment of HIV disease, as these patients are few in number and only served by a few pharmacies. A pharmacy may not stock a medicine on the list only if it has not been purchased in six months.

However, if the patient wants it, the pharmacy must order the medicine and deliver it.

Only the medicines with the lowest co-payments will be included in the list of reimbursable medicines that must be available in the pharmacy. This is to ensure that patients always have access to medicines with the lowest possible co-payment when they go to the pharmacy.

Irma Medžiaušaitė. VLK nuotrauka.jpg

Irma Medžiaušaitė, Senior Advisor to the Pharmaceuticals Reimbursement Division of the  National Health Insurance Fund (NHIF photo)

What if the medicine is not available?

Sometimes patients are faced with a situation where the medicine they need is not available in the pharmacy. In this case, pharmacy staff can order the medicine and have it delivered: within 2 days in the cities and within 4 days in rural areas. If a supply disruption results in the necessary medicine not being available in the country at all, the pharmacy must offer another medicine with the same active ingredient.

“Patients can buy reimbursable medicines at any Lithuanian pharmacy. It is important that the treatment continues and that the most appropriate medicines are chosen for this purpose,” I. Medžiaušaitė emphasizes. 

How is the lowest co-payment guaranteed?

The Medicines Reimbursement Scheme allows patients to choose the medicine with the lowest co-payment. Pharmacists have to show the patient a list of all medicines with the same active ingredient but from different manufacturers using a computer system. Those medicines with the minimum co-payment are listed in the system and displayed on the first line of the screen.

“Each year, the purchase of reimbursable medicines with the lowest co-payment leads to the creation of a ‘co-payment basket’. When the cumulative amount of co-payments reaches EUR 59.04 in 2025, the patient will not have to pay extra for the cheapest medicines by the end of the year – the co-payment will be covered 

The NHIF aims to prevent patients from overpaying for their treatment. This year, the list of must-have medicines includes 199 names. This number ensures that there is a sufficient choice of reimbursable medicines at the lowest co-payment, so that patients can get the medicines they need at the minimum co-payment and start their treatment on time.

Patient memo

  1. Choose the medicine with the lowest co-payment. Check with your pharmacist before you buy medicines and ask him to show you the prices of all manufacturers.
  2. Don’t overpay for medicines. Follow your co-payment basket. When it reaches EUR 59.04, you won’t have to pay for reimbursable medicines with the lowest co-payment for the rest of the year.
  3. Don’t forget your rights. If the medicine you need is not available at the pharmacy, it must be ordered and delivered within 2 or 4 days, depending on your location.

Pharmacies, that have a contract with the health insurance funds, are obliged to comply with the requirements to ensure the availability of reimbursable medicines. “If you encounter a situation where a pharmacy is unable to offer you the medicine you need or does not provide you with the right information, you can contact the health insurance funds,” the specialist advises.

(Freepik photo)

The NHIF invites you:

Last updated: 24-02-2025

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