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.
|Price of prescription medication||Co-payment|
|€12.00||€5.00 (minimum co-payment)|
|€80.00||€8.00 (10% co-payment)|
|€150.00||€10.00 (maximum co-payment)|
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.
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.
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.