Medications

Outside the scope of health and maternity insurance, a distinction must be made between prescription-only medication and over-the-counter medication, which is available under the control of the pharmacist but does not require a prescription to be dispensed.

For a medication to be reimbursed in full or in part, the protected person needs a doctor's prescription. The medication must also appear on a list known as the "Positive List", which is published by the CNS on its website and updated regularly.

For medication, the rule is one prescription per patient and per consultation, with exceptions. In principle, the prescription is valid for 3 months from the date of issue, unless otherwise specified. If the prescription provides for successive deliveries of medication, the last delivery must be made no later than 6 months after the first delivery.

If the prescription does not specify the duration of treatment, the smallest pack on sale will be reimbursed by the health insurance.

In Luxembourg, prescribed medications are generally dispensed in pharmacies open to the public. Non-prescription medications can also be purchased in these pharmacies at the request of the insured or on the advice of the pharmacist. Pharmacists play an important counselling role.

The pharmacist ensures that products are used correctly by checking medical prescriptions and the products dispensed. They also give instructions on how to take them (duration of treatment, quantity and method of administration), and warn of interactions with other medications, foods or substances such as alcohol. They can also provide information on possible undesirable side effects.

As a general rule, third-party payment is applied to cover the cost of medications. This means that the insured person presents their social security card and prescription to the pharmacist, and pays only the part not reimbursed by the CNS or not covered by the third-party payment system. In other words, the insured only pays the difference between the public price of the medications and the amount reimbursed by the health insurance.

A receipt is issued in exchange for the original medical prescription or certified copy, which the pharmacist keeps after the medications have been dispensed. The reimbursement rate is shown on the reimbursement statement and can also be consulted on the positive list of medications.

In Luxembourg, health insurance reimburses all or some of the medications on the positive list of medications, which is regularly updated by the CNS and published in the Mémorial. This list includes medications that have received marketing authorisation, a public price and whose inclusion has been requested from and granted by the CNS.

The medications are classified into three categories and benefit from a specific reimbursement rate:

• 40% for medications of moderate interest and intended for the treatment of symptoms of benign pathologies,
• 100% for medications with a specific therapeutic indication and
• 80% for all other medications.
  

Medications that are not on the list are usually not reimbursed.

Homeopathic medications are reimbursed if they appear on a specific list of homeopathic medications, which is validated by the CNS and updated periodically. The list of homeopathic medications can be consulted on the CNS website.

Substitutable medications

Substitutable medications are medications with the same therapeutic activity but at a lower price than the prescribed medication.

In accordance with system of substitutable medications, groups of medications have been identified for which pharmacies must offer a cheaper substitute.

Groups of substitutable medications

This currently applies to two groups of medications:

• lipid-lowering medications (statins) and
  
• gastric acid secretion inhibitors (proton pump inhibitors - PPIs).

If a medication from one of the two groups is prescribed, the pharmacist compares its public price with the reimbursement base set by the CNS for this medication.

Dispensing the prescribed or substitutable medication

There are two possible scenarios:

1. If the price of the medication prescribed is less than or equal to the calculated reimbursement base, the pharmacist may dispense the medication prescribed.
2. If the price of the medication prescribed is higher than the calculated reimbursement base, the pharmacist must offer the patient a substitution with the cheapest medication in the same group. The pharmacist informs the patient that the substitution does not affect the doctor's prescription and that the medication is just as effective.

Insured's choice

The insured person has the choice of taking the proposed substitutable medication or refusing it.

• Accept: By accepting the substitutable medication offered by the pharmacy, the patient helps to reduce reimbursement costs without jeopardising the efficacy and safety of their treatment.
• Refusal: If the insured person refuses the substitution by a therapeutically equivalent medication, and is dispensed the medication indicated on the prescription, they will have to pay, in addition to the part not covered by the CNS (reimbursement rate 80%), the difference between the fixed reimbursement base and the public price of the medication dispensed.

Other medication excluding substitutable medications

In principle, the pharmacy dispenses the medication prescribed by the doctor or requested by the patient. However, if a requested medication is out of stock or unavailable, the pharmacist can find solutions to replace the medication prescribed or requested by the patient.

Whether costs are covered depends on whether the medication or medical device was purchased in an EU, EEA or Swiss country or outside the EU. A distinction must also be made between a purchase made as part of an emergency abroad and a planned purchase abroad.

Purchase in an EU, EEA or Swiss country

Purchase in a country outside the EU, EEA and Switzerland