Medicine (specialty drugs and pharmacists’ preparations) is prescribed by the doctor in charge.
If the medicine is described by doctors using a valid health fund prescription form, insured persons can receive these drugs at any pharmacist against payment of a EUR 6,10 prescription fee per packet.
Health fund prescriptions have to be used within a month from the prescription date.
Converting a private prescription into a health fund prescription
A private prescription issued by a non-accredited doctor or hospital out-patient department can be converted into a health fund prescription before the medicine is received. This can be done by the following persons/institutions: doctors under contract, doctors at the WGKK branches (addresses) or the WGKK’s Medical Service (customer centre Wienerberg/ground floor).
Through conversion, the bill can be settled directly with the pharmacy and, apart from the prescription charge, no additional costs arise.
If a drug that can be freely prescribed - which includes most medicine - is prescribed, a private prescription can also be converted directly at the pharmacy. A special sticker is applied to the back of the private prescription, which is thus made equivalent to a health fund prescription. The insured person has to confirm the entitlement vis-a-vis the WGKK with his or her signature and has to enter the required data.
If a private prescription is marked “private” or with a similar note, though, it cannot be converted. In these cases patients have to bear the costs of the medicine themselves.
Cost reimbursement with private prescriptions
Without conversion, the costs for these medicines have to be pre-financed by the patients. In such a case, 80 percent of the costs that would incur to the WGKK can be reimbursed for such privately purchased drugs.
Prerequisite: the prescription follows the guidelines for economical prescriptions and it is not a private prescription issued by doctors under contract (health fund prescription marked “private”).
The following documents are required for reimbursement of costs:
- the prescription (with the name of the patient and the date of issue)
- proof of purchase (pharmacist’s stamp and price on the prescription or pharmacist’s receipt)
Why are some medicines subject to a head physician’s approval?
- Because mainly certain high-price, specialised drugs have only been approved for a particular group of patients.
- Because drugs newly introduced in the market are, in the first stage, only to be provided to persons who do not have any alternatives.
- Because thus the correct use can be safeguarded through the provision of centres, especially in the case of very specialised medicine such as cancer drugs.
- Because the WGKK has a statutory obligation to make sure that drugs are prescribed economically.
- Because in this manner cost increases with drugs can be kept under control.
Long-term approval for certain medicine
For persons that have to take medicine subject to a head physician’s approval over a longer period of time, the doctor in charge can get long-term approval electronically and later deduct the drugs actually used.
More information on the need to have medicine approved:
Telephone: +43 1 601 22-2165