Reimbursement for medicines
For some medicines you will receive a refund under certain conditions.
Pharmaceutical specialties
These are packaged medicines that the pharmaceutical industry produces: branded products, copies and generic medicines.
More infoPainkillers for chronic pain patients
Some patients with chronic pain receive reimbursement for paracetamol. This way they only pay a limited part instead of the full amount.
More infoMedicines with prior approval
For a number of medicines you need prior permission to receive a refund. This approval is given by CM's consulting physician.
More infoPharmaceutical specialties
These are packaged medicines that the pharmaceutical industry produces: branded products, copies and generic medicines.
Health insurance reimbursement
The reimbursement category of a medicine indicates the extent to which CM provides reimbursement. This is done according to the principle of reference reimbursement. This means that health insurance will reimburse less for a branded drug if there is a cheaper alternative. Then there will be a supplement to the maximums below.
You are simply insured: no personal share
You have VT : no personal share
You are simply insured
Limited personal share, with a maximum of 12.10 euros (or 15 euros for a large package).
You have VT
Limited personal share, with a maximum of 8.00 euros (or 9.90 euros for a large package).
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The personal share (co-payment) is the amount that the patient pays. The difference between the official rate and the reimbursement by the health insurance.
Large packages contain more than sixty units.
You are simply insured
Limited personal share with a maximum of 15 euros.
You have VT
Limited personal share with a maximum of 9.90 euros.
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The personal share (co-payment) is the amount that the patient pays. The difference between the official rate and the reimbursement by the health insurance.
You are simply insured
High personal share (no maximum)
You have VT
High personal share (no maximum)
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The personal share (co-payment) is the amount that the patient pays. The difference between the official rate and the reimbursement by the health insurance.
You are simply insured
Full personal share (no refund)
You have VT
Full personal share (no refund)
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The personal share (co-payment) is the amount that the patient pays. The difference between the official rate and the reimbursement by the health insurance.
For some specialties there is no reimbursement from health insurance. This concerns category D:
- basic painkillers;
- some tranquilizers and sleeping pills;
- most vitamins.
There is reimbursement for certain painkillers for patients with chronic pain.
Prescription
Doctors, dentists and midwives can prescribe medicines.
You have three months to collect medication from the day the prescription is written. This period can be shorter or longer if the prescriber puts an end date on the prescription.
The reimbursement period by CM is equal to the validity period of the prescription.
Prescribers may only issue electronic prescriptions, except in these situations:
- in case of hospitalization;
- the prescriber is at least 65 years old;
- the prescription is drawn up outside the cabinet (e.g. a home visit or in a guard post);
- in case of force majeure.
A paper printout is no longer necessary. The pharmacist reads your electronic identity card and can thus consult the prescriptions in your name.
You can also consult your prescriptions yourself on the online platform MijnGezondheid.be or with the My Medicines app.
Can someone else pick up medicines prescribed in my name?
Yes, a person designated by you can collect your medicine.
What if I don't have my identity card with me?
Then there are two possibilities/
- Your national register number also gives the pharmacist access to your electronic prescriptions.
- You can also log in to the portal mijngezondheid.belgie.be at the pharmacy and show your prescription.
Do I have to collect all prescription medicines at the same time?
No, there is one prescription for each medicine. So you can pick up one medicine and pick up another medicine later. Please take into account the three-month repayment period.
Can I ensure that a pharmacist does not see all my electronic prescriptions?
Yes, it is possible to make one or more prescriptions visible for one pharmacy of your choice. You can do this yourself at mijngezondheid.belgie.be or under the guidance of your doctor. Don't hesitate to discuss this with your healthcare provider.
Are there electronic prescriptions for physiotherapy or home nursing?
No, for the time being these will remain on paper.
Where can I find more information?
On the Recip-e website you will find various videos for patients about electronic prescriptions.
Which medicine should the pharmacist dispense?
The cheapest. Medicines come in many varieties, but all contain the same active ingredients in the same dose. The price of the variants can vary greatly. Generic drugs are usually the cheapest.
If your doctor prescribes a medicine by substance name , your pharmacist is obliged to supply the cheapest medicine. Every month, the Riziv draws up a list of medicines that meet the criteria.
That is a good thing for the patient. Manufacturers sometimes lower their prices to be on the list of cheapest medicines. This also results in savings for health insurance.
If your doctor prescribes a brand name medicine, the pharmacist must give you the exact medicine stated on the prescription.
The rules are stricter for antibiotics (against bacterial infections) and antifungals (against fungal infections). Even with a brand name prescription, the pharmacist must give you the cheapest version of the medicine.
Your doctor can only demand that the pharmacist supply you with a specific (more expensive) branded medicine for medical reasons. For example, if you are allergic. In that case, your doctor must explicitly state this on the prescription. He must also keep track of why you need that specific brand in your file.
Reimbursement of medicines with prior approval
For a number of medicines you need prior permission to receive a refund. This approval is given by CM's advising doctor, who checks whether you meet the conditions.
The doctor who prescribes the medicine submits the application for reimbursement electronically or on paper to CM.
1. Request
The prescribing physician sends the reimbursement request to CM via his software.
2. Control
CM performs a number of automatic checks.
3. Answer
The prescribing doctor receives an immediate response:
- Approval - The 'Agreement to Refund' certificate will be sent to you.
- Refused - The prescribing doctor immediately sees why you do not meet the criteria. You will not receive a letter.
- Under treatment - The advising doctor checks whether the conditions have been met. The decision will be sent to you.
4. Collect medicine
- Agree - With the certificate and prescription you collect the medicine from the pharmacist. You only pay the co-payment.
- Refused - In consultation with your doctor, you look for a cheaper or better alternative. Do you still choose this medicine? Then you pay the full price.
1. Request
The doctor who prescribes the medicine draws up the reimbursement application.
2. Submit
You submit the application to CM's advising physician .
3. Control
The advising doctor checks whether the conditions are met.
4. Decision
- Agreement - The conditions have been met: the advising doctor issues an 'Agreement for reimbursement'.
- Refused - The conditions are not met: the advising doctor issues a 'Refusal of reimbursement'.
5. Collect medicines
- Agree - With the certificate and prescription you collect the medicine from your pharmacist; You only pay the co-payment.
- Refused - In consultation with your doctor, you look for a cheaper or better alternative. Do you still choose this medicine? Then you pay the full price.
- Investigation : the Medicines Reimbursement Committee , an organ of the National Institute for Health and Disability Insurance (RIZIV), investigates whether a medicine should be reimbursed. She looks at the therapeutic value and the price.
- Decision : based on the committee's advice, the Minister of Social Affairs decides whether a medicine will ultimately be reimbursed.
For some medicines, reimbursement is limited to certain target groups. They must meet the legal conditions for reimbursement. Therefore, for some medicines, prior permission from the consulting physician is required.
Magisterial preparations
These are medicines that the pharmacist makes himself based on a prescription.
Health insurance reimbursement
The health insurance fully reimburses some pharmaceutical preparations. For most of them you also pay a part yourself, the co-payment. The amount of the co-payment is fixed per quantity. So regardless of the composition of the preparation.
Below you will find the co-payment for the most common amounts:
Painkillers for chronic pain patients
Some patients with chronic pain receive reimbursement for paracetamol . This way they only pay a limited part instead of the full amount. The amount you pay counts towards the maximum invoice .
For the time being, the refund only applies to certain packages of paracetamol.
Your doctor must request reimbursement from the advising physician. If they approve your application, you are entitled to a refund for life.
You suffer from any of the following:
- cancer pain;
- chronic arthritis or osteoarthritis pain;
- neurogenic or neuropathic pain of central or peripheral origin (also multiple sclerosis);
- peripheral vascular pain;
- pain after surgery (also phantom limb pain);
- fibromyalgia.
The home pharmacist
If you have a chronic condition, you can choose a home pharmacist. They will give you free personal advice about your medication use.
The home pharmacist:
- has an overview of your medication;
- draws up and adjusts a medication schedule for you;
- works together with your doctor and other healthcare providers;
- acts as a contact person for all information about your medication.
You can always change pharmacists and get your medication at any pharmacy.
You can terminate the agreement at any time.
The medication schedule:
- is a reliable overview of both your prescribed medicines and over-the-counter medication;
- contains useful information about each medicine such as dosage and time of intake;
- can be shared with other healthcare providers.
Sign an agreement with your pharmacist of choice. Which includes:
- permission to exchange your health information electronically with other healthcare providers;
- permission to have access to a complete overview of your treatment by maintaining your pharmaceutical file.
You use medicines for a long time or take multiple medicines every day.