When a medicine is eligible for conditional reimbursement, reimbursement is only given automatically if it is prescribed for certain diseases or patient groups. Reimbursement is triggered if the doctor has written the Danish word “tilskud” (reimbursement) on the prescription, or has otherwise indicated that the prescription is to be registered with reimbursement, e.g. by tick-off or other. Naturally, the doctor is only permitted to indicate that the prescription is to carry reimbursement if the patient fulfils the reimbursement condition. This way, it is ensured that reimbursement is targeted exactly those patients who can be treated rationally with the medicine in question.
If the patient does not fulfil the reimbursement condition, the doctor can apply for single reimbursement for that patient’s purchases of the medicine.
Many pharmacies have informed the Danish Medicines Agency that doctors write the Danish word “tilskud” (reimbursement) on the prescription even though the patient does not fulfil the reimbursement condition. If the pharmacy accepts the prescription with reimbursement, the patient receives reimbursement to which he or she is not entitled. This undermines the foundation for maintaining general conditional reimbursement for the medicine and constitutes misuse of the Danish society’s money.
There are also examples of doctors who have written an incorrect diagnosis on the prescription for the sole purpose of obtaining – unjustified – reimbursement for the patient. For example, a doctor would write e.g. epilepsy which together with the word “tilskud” (reimbursement) would trigger reimbursement, even though the medicine is in fact prescribed for pain relief. If another doctor should subsequently retrieve information about that patient’s medication in the Medicine Profile – e.g. if the patient goes into hospital – these incorrect prescription details could put the patient’s safety at risk.
The conditions applicable to medicines with conditional reimbursement are available on the internet, both at pro.medicin.dk under each individual medicine and at the website of the Danish Medicines Agency, prescription medicines with conditional reimbursement and over-the-counter medicines with conditional reimbursement (in Danish only).
The Danish Medical Association and the Danish Medicines Agency recognise that in the process of prescribing a medicine to a patient, it may not be easy for doctors to obtain an overview of the reimbursement conditions for all medicines, and possibilities are therefore being explored for integrating a pop-up feature into the various medical systems used by doctors. Such a pop-up feature could inform the doctor about the reimbursement conditions that apply to the medicine concerned.
The Danish Medical Association and the Danish Medicines Agency urge everyone to use the conditional reimbursement scheme correctly and in compliance with the intentions behind the scheme.
The Danish Medical Association and the Danish Medicines Agency
March 2011
