Raised limits in the high-cost reimbursement scheme on January 1st 2023

 
According to the new levels in the high-cost reimbursement scheme, you as a pharmacy customer will never pay more than SEK 2,600 during a twelve-month period for medicines and other assistive products covered in the high-cost protection scheme

The first time you fill your prescription after January 1st 2023, you may have to pay a one-time fee according to the table below. This is because the limits and discount levels in the high-cost protection scheme are raised at the turn of the year.

The purchases you have already paid for during the current high-cost period will be transferred to the new period.

The high cost protection for medicines applies to the majority of prescription medicines and protects you from high medicine costs. Medicines included in the reimbursement scheme are discounted by the government. This means that the government pays part of the cost.

You pay the actual cost for your medicines up to SEK 1,300. After that the high-cost protection scheme is activated and you will start to get a discounted price.

In the e-service “Läkemedelskollen”, you can see your high-cost benefits and how much you have paid during your high-cost period. You can also request an extract from the high-cost database from the E-health agency.

The one-time fee may differ slightly between two levels, from what is stated in the table, but it will never be higher than SEK 150.92. Please note that in some cases the one-time fee can be divided over several purchases because you never pay more than what the medicine costs without a rebate.

The increases in the high-cost protection are due to the fact that the price base amount for 2023 has been increased to SEK 52,500.

If you have paid SEK 2,400 no later than December 31, 2022 and obtained medicines with 100% rebate you will keep the rebate as long as it is valid. Only then do you start a new 12- month period in the high-cost benefit scheme.

About the price base amount

The price base amount is used, for example, to calculate various benefits and fees. It is Statistics Sweden, SCB, that calculates how large the price base amount should be, based on the general price situation. The government then decides on the price base amount for each year.

Examples of how pharmacy customers are affected by a raised limit in the high-cost reimbursement scheme

Robin reaches the second level in the reimbursement scheme.

Robin has bought medicines that are covered by the high-cost reimbursement scheme for SEK 1,100 in 2022. Therefore, Robin did not reach any rebate level in the high-cost threshold in 2022.

In January 2023, Robin buys a medicine that costs SEK 559. The new high-cost reimbursement scheme applies directly to Robin because she now ends up over the limit for the second level, which from January 1, 2023 is SEK 1,300.

Robin pays the full cost of his medicine until she reaches the second step in the new high-cost level, SEK 1,300. She then pays 50 percent of the remaining cost of the medicine. (200 kroner plus half of 359 kroner, i.e. 179.50 kroner). In this case, Robin's cost will be SEK 379.50.

Kim reaches the third level in the reimbursement scheme.

Kim has bought medicines for SEK 1,900 in 2022 and then reached the third level in the high-cost reimbursement scheme, where the customer pays 25 percent of the cost.

In January 2023, Kim buys a new drug that costs SEK 200. He then pays a total of SEK 147.72 for his medicine.

The SEK 147.72 Kim pays consists of two parts.

The first part, SEK 50, is paid by Kim because he is on the third level of the high-cost reimbursement scheme and must be responsible for 25 percent of the cost of the medicine by himself. The second part, SEK 97.72, is the one-time fee.

Tintin reaches the highest level and gets a full discount.

Tintin has bought medicines for SEK 2,400 in 2022 and then reached the limit of the high-cost protection for medicines and received a 100 percent discount for medicines.

When Tintin goes to buy medicine in January 2023, she does not have to pay anything for it because she already has a full discount. The full discount is valid for its entire period of validity, even if there is an increase in the limit of the high-cost reimbursement scheme.