CNAS proposes criteria for modifying drug reimbursement, without major increases

The National Health Insurance House announced on Friday that it has identified and proposed to the Ministry of Health a series of additional criteria for modifying the compensation level of evaluated medicines, so that the real impact on the personal contribution due by the insured is as moderate as possible, and specified that vulnerable persons will not be affected, maintaining the current compensation level for them.

The CNAS reply comes in the context of information appearing in the public space according to which patients would have to bear significant increases in the personal contribution for reimbursed medicines (of the order of 500-600 RON/month/medicine).

According to a press release from CNAS, only in the case of 13 drugs is the compensation level expected to change, as follows:

* transition to a 20% compensation level (moving from sublists A and B to sublist D) for drugs (INN) - Indapamidum, Metoprololum, Bisoprololum, Combinations (Perindoprilum + Indapamidum), Candesartanum Cilexetil, Rosuvastatinum, Nebivololum, Rilmenidinum and Atorvastatinum;

* transition to a 50% compensation level (moving from sublist A to sublist B) for the drugs (INN): Fenofibrat, Omeprazol, Combinations (Spironolactonum + Furosemidum) and Amoxicillinum + Acidum Clavulanicum.

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In the event that the ANMDMR decisions were implemented, the personal contribution would increase on average compared to the current one by approximately 9 lei/box for a prescribed medicine from the 13 mentioned, states CNAS.

"Vulnerable categories of the population would not be affected, maintaining the current level of compensation of 100% of the reference price of medicines for children, young people (18 - 26 years old) who study and do not earn an income, pregnant women, lactating women and beneficiaries of special laws, and 90% for pensioners beneficiaries of the medicine price compensation program from sublist B. CNAS reaffirms that patients in Romania will not be burdened with excessive personal contributions, and the statements circulated in the public space regarding additional costs of hundreds of RON per month for these compensated medicines are false and create unnecessary panic," the press release reads.

In 2024, ANMDMR evaluated a number of 18 medicines (active substances - INNs) that met the criteria, according to the law, for modifying their compensation level.