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Diabetes and reimbursements for medicine expenses

You may receive a reimbursement from Kela for prescription drugs. The amount of reimbursement depends on the medical condition, its treatment as well as the product.

Infographic on KELA medication reimbursements.

You will receive compensation for drugs, clinical nutritional products and emollient creams with a verified reimbursability, which are prescribed for the treatment of your medical condition. The reimbursability is decided by the Pharmaceuticals Pricing Board (HILA), which operates in connection with the Ministry of Social Affairs and Health.

The amount of reimbursement for prescription drugs depends on the medical condition, its treatment as well as the product. The reimbursements for medicinal products are divided into basic reimbursement (40%) and special reimbursement. There are two special reimbursement categories: the lower special reimbursement of 65% and the higher special reimbursement of 100% after the deductible applicable to the medicinal product.

You are only entitled to reimbursement after the annual initial deductible (EUR 50) and at maximum for 3 months of medication at a time. The amount of medicine is calculated on the basis of the dosage instructions in the prescription, which must therefore be up to date and updated in case the dose changes.

Entitlement to reimbursement id applied from Kela on the basis of a medical certificate B issued by a doctor. If the entitlement to reimbursement is granted, a new Kela card with the reimbursement entitlement number will be sent to your home address.

As a rule, insulin products are subject to the higher special reimbursement (100%). In this case, once the annual deductible of 50 euros has been paid, you will pay a purchase- and product-specific deductible of 4.50 € for the product, and the price exceeding this amount will be reimbursed in full. An exception to this is temporary insulin therapy during pregnancy, which is subject to the basic reimbursement (40%). For some insulin products, the reimbursement may be subject to special terms and conditions.

As a rule, other diabetes medicine products than insulin are subject to the lower special reimbursement (65%). All medicinal products meant for the treatment of diabetes are not necessarily reimbursable, or their reimbursability may be subject to special terms and conditions.

Often, a person with diabetes also uses medicinal products to treat high blood pressure and cholesterol. In general, these medicinal products are subject to the basic reimbursement (40%). With regard to the treatment of both blood pressure and cholesterol, there are specific medicinal products which qualify for the lower special reimbursement (65%).

There is a specific limit for the medical products subject to reimbursement, i.e. annual maximum limit on out-of-pocket costs for a calendar year. The initial deductible (50 euros) and the self-paid share of the price of reimbursed prescription products accumulate toward the limit. If the annual limit is exceeded, you are entitled to additional reimbursement payable at the pharmacy when buying medicinal products. Once the limit has been reached, you pay a deductible of EUR 2.50 per purchase and drug for each reimbursable product.

Updated 8.11.2023