Reimbursement for the chronically ill
If you are chronically ill, you may incur very large expenses for medicine. A ceiling is put on your expenses, if you are granted reimbursement for the chronically ill. The ceiling is with a user charge of DKK 3,490 calculated in reimbursement prices.
Application
Your doctor must apply to the Danish Medicines Agency for reimbursement for the chronically ill. When your application is assessed, it is emphasised whether your treatment is well-founded and that the total annual expenses for medicine with reimbursement appears to exceed DKK 16,131 (your balance in the CTR). If you are under 18 years old, the expenses must be believed to exceed DKK 19,888.
Reply
Usually, the Danish Medicines Agency replies to the doctor’s application for reimbursement for the chronically ill within 14 days. However, it may take up to two months if an application requires special assessment.
If the application is granted, you will receive a reimbursement grant in the mail and pharmacies will also be able to see in the CTR that you are entitled to reimbursement.
Your doctor will be notified if the application for reimbursement for the chronically ill is rejected. The doctor is also given a reason for the rejection.
How does reimbursement for the chronically ill work?
When you are entitled to reimbursement for the chronically ill, you receive 100% in reimbursement for medicine eligible for reimbursement, when your balance in the CTR exceeds DKK 16,131 (DKK 19,888 if you are under 18 years old). Therefore, you can only get to pay a maximum of DKK 3,490 for your annual consumption of medicine eligible for reimbursement.
Yet, it is a requirement that you always buy the least expensive medicine in a group of synonymous medicines. Otherwise, you have to pay the entire price difference between the least expensive and the more expensive medicine that you might buy.
How long is reimbursement for the chronically ill valid?
Most reimbursements for the chronically ill are valid for 5 years. The reimbursement is valid in both the reimbursement years which it overlaps, i.e. from the beginning of the reimbursement year that is under way when the reimbursement is granted and to the end of the reimbursement year when the reimbursement expires. Hence, the doctor need not apply again until near the expiry date of the reimbursement.
What does a reimbursement for the chronically ill cover?
A reimbursement for the chronically ill covers all kinds of medicine eligible for reimbursement, when you reach the balance that results in 100% reimbursement. This applies both to medicine with automatic reimbursement and to medicine for which you have been granted single reimbursement.
Danish Medicines Agency, updated 4 January 2010
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