المملكة: Health insurance: 20% maximum for bearing the cost of the generic drug…and 50% for the innovator

Select Health Insurance Council A mechanism for insurance beneficiaries to bear the participation rate when dispensing medications, indicating that it reaches a maximum of 20% for the generic drug and 50% for the innovative drug, to ensure that they receive the treatment they are entitled to.

The Council indicated that the beneficiary’s participation rate for the generic drug ranges between 0% and 20% of the cost. He added that this percentage ranges between 0% and 50% for the innovative drug, due to its direct connection to the conditions and coverage of the health insurance policy.

The Council clarified the rights of the beneficiaries in the event that the generic drug is not available in the reviewed pharmacy, explaining that in this case the patient has the right to obtain the prescription and have the drug dispensed from another pharmacy in which it is available.

It revealed the procedure followed in the event of a complete discontinuation of the generic drug from markets or pharmacies. He stressed that the innovative drug will then be dispensed to the beneficiary, with the same tolerability rate set for the generic drug applied without any increase.

The Council pointed out that these regulatory measures mainly aim to ensure the continuity of beneficiaries’ access to their medications. He stated that this contributes to organizing the mechanism for calculating the participation rate, in full accordance with the benefits of the health insurance policy.