Health Systems in Transition - Hungary - World Health Organization ...

Health systems in transition Hungary 151
the use of pharmaceutical treatment for a given patient (2005/4). Only one
pharmaceutical is allowed per prescription (2004/5). The prescription must
include information about the patient and the prescriber, the name of the
pharmaceutical or its active ingredient, its quantity and its dosage (indicated
daily dose) (2004/5). The prescribed quantity may not exceed the quantity
necessary for one month’s treatment, with the exception of patients with chronic
conditions to whom pharmaceuticals can be prescribed for up to three months
or, in exceptional cases, up to one year (2004/5).
There are two major types of reimbursement: indication-related and fixed. In
the first category, the indication for a certain substance needs to be confirmed
by a specialist. Some pharmaceuticals for less severe chronic conditions are
covered up to 90%, 70% or 50% of the agreed retail price, while medications
for the more severe, life-threatening diseases are covered 100% (however,
in most cases a minimum patient co-payment, the so-called package fee, of
approximately €1 must still be paid). In the second category, all indications
determined in the licence of a medication are covered, either up to a fixed
amount (through the reference pricing system) or on a percentage basis (80%,
55% or 25% of the agreed price). The reference pricing system is used for
products with identical active ingredients or similar therapeutic effects. In the
case of products with identical active ingredients, the basis for reimbursement is
the daily treatment cost of the reference product, which is the product available
on the market for at least six months with the lowest daily treatment cost and
with a market share exceeding 1% (as expressed in days of treatment). All
pharmaceuticals containing the same active ingredient receive the same subsidy
per daily dose. The reference pricing system also applies to products with
different active ingredients but similar therapeutic effects (2004/4). Further
information on reimbursement can be found in section 2.8.4.
There is a system of exemptions from user charges for pharmaceuticals,
medical aids and prostheses, and rehabilitation services for social service
beneficiaries (1993/1). When this system was introduced, eligible individuals
received all pharmaceuticals on a special list free of charge, with no consumption
or spending limits. In 2006 the government introduced new rules to tackle
abuse of the system. Eligible individuals are now granted a monthly personal
budget of up to HUF 12 000 (about €45) to cover user charges on recurrent
health expenditure associated with chronic diseases; these individuals also
have an addition budget of HUF 6000 (about €24) for acute problems (2005/8).
The range of accessible medicines is no longer restricted, but any spending
above the budget ceiling must be paid out-of-pocket. Entitlement to user charge