Medicines and dressings

If your doctor gives you a prescription covered by health insurance, we cover a majority of the cost. You pay a small amount towards it yourself – what’s known as a co-payment. The co-payment for prescription medication is generally 10% of the sales price – at least €5.00 and no more than €10.00. You will never pay more than what the medicine actually costs. This means that medication costing less than €5.00 is exempt from co-payments. 

Co-payment examples:

Who is exempt from co-payments?

In general, no co-payment is made in the following cases:

• Children and adolescents under the age of 18 are exempt from co-payments.

• Medicines prescribed in relation to pregnancy and childbirth are also exempt from co-payments.

In addition to these cases, individuals for whom their co-payments exceed their ‘co-payment limit’ are also exempt from co-payments. This co-payment limit is equal to 2% of their gross income for the calendar year. The co-payment limit is reduced to 1% for individuals with chronic illnesses. These people can request co-payment exemption for the current calendar year. Find out more about this rule on the ‘Co-payment exemption’ page. 

Discount agreements

We have concluded ‘discount agreements’ with pharmaceutical companies for many prescription medicines. When your doctor prescribes you a medicine, your pharmacist will then give you a discounted preparation with the same active ingredient from a participating SBK partner. 

These cost savings allow us to provide our insurants with high-quality care at affordable prices. You can also see the benefit of these savings specifically in the stability of your contribution rates. 

Your personal consultant can provide you with information on our current discounted medicines.

In exceptional cases with a legitimate medical reason, your doctor can still prescribe you a specific medicine by crossing the ‘Aut idem’ (a Latin term used by medical professionals that means ‘or the same’) box on the prescription. So don’t worry: no SBK insurant will be forced to take medicines to which they have an intolerance or to pay for necessary medicines out of their own pocket.

Fixed amounts

The fixed amount is the maximum amount that statutory health insurers – including SBK – are permitted to cover for a prescribed preparation. Fixed amounts for medicines are defined by the National Association of Statutory Health Insurance Funds and are binding for all statutory health insurers across the board. 

If the price of a medicine as defined by the manufacturer exceeds the fixed amount, the patient must pay the difference out of their own pocket, in addition to the co-payment. The difference therefore represents an additional cost. In this case, you can ask your doctor to prescribe an alternative that would not come with additional costs, as such alternatives do generally exist.

Doctors can issue prescriptions for medicines and dressings on pink, yellow, blue and green forms. The prescription colours dictate the validity of the prescription and how costs are handled. 

Pink – prescriptions covered by health insurance

Doctors can and must prescribe prescription medicines that they deem to be medically necessary on pink prescription forms. These medicines must be included in the catalogue of services provided by statutory health insurance. The doctor treating you also needs health insurance approval. The prescribed medication is covered by SBK and you only have to pay the statutory co-payment. Prescriptions covered by health insurance are valid for four weeks. 

Yellow – narcotics prescriptions

Yellow prescription forms are reserved for narcotics, such as strong painkillers. They are subject to especially strict rules in terms of how they are prescribed and dispensed. Narcotics prescriptions are valid for seven days from the time they are issued. 

Blue or non-form – private prescriptions

Doctors use blue forms or non-form prescription sheets to prescribe medicines for which there is no therapeutic necessity, for example, but the patient has expressed a desire for it. Doctors also use private prescriptions for ‘lifestyle preparations’, which are used to prevent hair loss or aid weight loss, for example. Private prescriptions are valid for three months unless the doctor specifies otherwise. 

Green – recommendations 

Green prescription forms are used for non-prescription medication that is recommended by the doctor as a therapy aid but is not medically necessary. SBK is not allowed to cover the cost of non-prescription preparations for economic reasons. Recommendation prescriptions are valid for an unlimited amount of time. 

By the way, you can also get a medicine prescribed on a green prescription form from your pharmacist at any time, even without a doctor’s recommendation.

Some medicines you can simply purchase from your pharmacist without needing a prescription. You generally pay for these medicines yourself, even if they have been prescribed to you. This includes the following medicines:

• Cold and flu medicines

• Laxatives

• Mouthwashes

• Travel medicines

There are some exceptions for certain groups of individuals and illnesses. These medicines are known as restricted prescription medication.

Restricted prescription medication

The costs of these medicines can be covered by us in the following cases:

• Medicines for children under the age of 12 or adolescents under the age of 18 with developmental disorders.

• Medicines that are a standard component of treatment of a serious illness, such as acetylsalicylic acid (aspirin) used as aftercare following heart attacks and strokes, antihistamines used to treat serious types of allergies or laxatives in conjunction with strong painkillers (opioids).

• When other measures or medicines are not effective.

These medicines must be included on prescriptions covered by health insurance and must only be available in pharmacies. Statutory co-payment rules apply to restricted prescription medication. 

Lifestyle preparations

‘Lifestyle preparations’ are not medically necessary and are mainly used to improve quality of life. Statutory health insurers – including SBK – are not allowed to cover the costs of these preparations. 

These include, among other things:

• Erectile dysfunction aids

• Smoking cessation preparations

• Medicines used to suppress the appetite or aid weight loss

• Preparations used to prevent hair loss