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System of counting of System of counting of reimbursement costs by reimbursement costs by

public payers public payers

National Health Insurance Fund Administration (OEP)

Pharmaceutical Department

TamTamáás Kovacss KovacsDeputy Head of Pharmaceutical DepartmentDeputy Head of Pharmaceutical Department

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Reimbursement through:

Public procurement by NHIFA

Hospitals

Pharmacies (also Patient name finance)

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Reimbursement through pharmacies

Patient Pharmacy

Co-payment

Pharmaceutical

Settlement System

Data

Reimbursement (5 days)

Control of the amount, and the ICD/code

patient ID, pharmaceutical, co-payment and reimbursement, date (prescription, taking out), pharmacy, MD, ICD-code

Wholesaler

Distributor

Money (30 days)

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Main elements

• Settlement frequency: 1, 2, or 4 times per month

• Money transfer: after 5 days

• Public list of reimbursed pharmaceuticals on the web-site of the NHIFA (sent to the Pharmacies)

• Credit for the Pharmacies (max. 28.000€/year)

• Subsidy for the Pharmacies (in small villages, little turnover, long opening time)

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Generating the retail price

Ex-factory price (free pricing)

Wholesale price

Retail price

VAT (5%)

Pharmacy Mark-up (17-26%, max. 3,5€)

(Average 19,46%)

Wholesale Mark-up (5-12%)

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Thank you for your attention!

kovacs.tam@oep.hu