Pharmaceutical financing
In Norway, prescription medicines are financed by the state through the reimbursable prescription regime, also called “blue prescriptions” and the regional health authorities (H-prescriptions and medicines used in hospitals), by other health institutions and by the patients through self-payment (usually called “white prescriptions”).
The Norwegian state pays approx. 80 per cent of the expenses related to prescriptions medications. 18 percent of the expenses are paid by the patient (deductible on blue prescription and white prescription. The rest is paid by other health institutions, primarily municipal.
Regional Health Authorities (RHAs), are the four regional institutions owning the public hospitals in Norway,. They takes an increasing part of the pharmaceutical costs. One of the main reasons is the inclusion of new medicines in the H-prescription scheme.
Blue prescriptions
Paid by the state: The National Insurance Scheme (NIS) covers expenses for medicines, medical supplies etc. prescribed by a physician for outside hospital-use. The coverage is limited to the treatment of serious illnesses or of risk factors that are likely to cause or intensify serious illness and where there is a need or risk of recurring treatment over a prolonged period of time.
Paid by the patient: The patients pay a co-payment for blue prescriptions. For 2023 the limit was 3 040 NOK.
The total self-payment for prescription drugs in 2023 amounted to NOK 1.9 billion, 6 % of total turnover.
H-prescriptions
For some medicines prescribed by hospital doctors, the RHAs are given a special financial responsibility, even though treatment is outside hospitals. This includes disease-modifying, biological drugs for of rheumatic disorders - the so-called TNF inhibitors, some medicines for the treatment of multiple sclerosis (MS) and cancer drugs etc.
In 2023 H-prescriptions was in total 6,7 billion NOK: a change of +1.9 % and a total share of total turnover var 19.4 %.
White prescriptions
Pharmaceuticals not covered by NIS, health authorities or municipalities are called white prescriptions and are generally paid by the patient. This often applies to short-term treatment, such as painkillers, sleepers, and antibiotics.
Price-Setting
The authorities decide the maximum price for prescription medicines in Norway and “trinnpris” for generics.
- The maximum purchase price for pharmacies is set by The Norwegian Medicines Agency as the average price of the three lowest market prices in nine European countries.
- The pharmacies’ maximum mark-up consists of a percentage addition to the pharmacies’ purchase price combined with a fixed additional amount per package, as shown in table:
|
AIP* |
% addition |
NOK per package |
NOK per package (A/B) |
Refrigeration addition |
|
All |
2.00 % |
29 NOK |
19 NOK |
0.5 % |
*Pharmacy purchase price
Price-setting for generics
Medicines that are subject to generic substitution should follow the system of “trinnpris” (“stepped prices”). The authorities have decided that pharmacies shall offer patients at least one generic alternative at a price that is considerably lower than the maximum price. These prices are called “trinnpris” (stepped prices). The price cut is up to 96 %.
Hospital medicines and secret prices
Hospital medicines are largely purchased on a tender basis and affect the medicines available for prescribing. An increasing number of expensive medicines are subject to tender and included in the formulary lists. Prescribing outside of formulary lists will be increasingly difficult. This also applies for H-prescriptions (see above).
The trend of transferring high-cost medicines to the H-prescription category is also a trend for less expensive drugs (e.g. for hepatitis B.)
The discounts which are achieved through tenders are confidential. Hence, the actual market prices (after discounts) are not publicly available information, but known to doctors, pharmacists, and other health-care professionals.