In Luxembourg, a total or partial reimbursement of medications purchased in pharmacies open to the public depends on whether or not the medication is recorded in the positive list of medications published in the Official Journal ("Mémorial").
Medications appearing on the positive list are divided into three separate categories. For each category, a specific coverage rate is provided:
- The reduced reimbursement rate is set at 40%. It applies to medications which present a moderate value or interest in common medical practices and which are used to treat symptoms of benign pathologies (with some exceptions).
- The normal reimbursement rate is set at 80%. It applies to all the medications from the positive list for which the CNS statutes do not provide another rate.
- The preferential reimbursement rate is set at 100%. It applies to medications which have a precise therapeutic indication, consisting of one active ingredient only, irreplaceable or presenting a vital interest in the treatment of particularly severe or chronic pathologies and likely to generate for the person an inappropriate participation in terms of costs. All conditions must be fulfilled at the same time.
Notwithstanding the condition of one active ingredient, the reimbursement rate of 100% may also be applied to medications which contain up to three active ingredients, where at least one, marketed on its own, is covered at the preferential rate and the others, marketed alone, at least at the normal rate.
Registration of a medication in the positive list
In order for a medication to be registered in the positive list of medications, certain conditions must be fulfilled.
Only medications which meet the following criteria can be registered in the positive liste: they must have a marketing authorisation, a public price and the holder of the marketing authorisation must have submitted a request to the CNS asking for the medication to be added to the positive list.
This request is made by using the form "Request for registration of a medication in the positive list of medications covered by the health insurance in the Grand-Duchy of Luxembourg" (Demande d’inscription d’un médicament sur la liste positive des médicaments pris en charge par l'assurance maladie au Grand-Duché de Luxembourg).
The decisions to register or not a medication on the list or to exclude a category or a certain product must be based on criteria set by article 17, paragraph 1 and article 23, paragraph 1 of the Social Security Code.
Unitary homeopathic medications manufactured from a vegetal, mineral or chemical source and marketed as globules, granules, tablets or drops may also be added to the positive list.
The president of the CNS or his delegate decides whether or not to register medications in the positive list and determines the applicable coverage rate, based on a motivated and mandatory opinion delivered by the Medical Board of the Social Security (Contrôle médical de la sécurité sociale CMSS).