Exceptional reimbursement of medications

Application for exceptional reimbursement of a drug

Processing of the application

Once the Health Insurance Fund has received both the doctor's justification and your application, the application will be reviewed. If anything is missing or needs clarification, you or your doctor will be contacted by letter or telephone.

A decision on the exceptional reimbursement of a medicine is usually made within 30 days of receipt of the documents. If the application needs to be supplemented, the deadline will start from the date when the deficiencies are remedied.

Once the Health Insurance Fund has received both the doctor's justification and your application, the application will be reviewed. If anything is missing or needs clarification, you or your doctor will be contacted by letter or telephone.

A decision on the exceptional reimbursement of a medicine is usually made within 30 days of receipt of the documents. If the application needs to be supplemented, the deadline will start from the date when the deficiencies are remedied.

If the medicine is not authorized for sale and a digital prescription application(Opens in new tab) must be submitted to the State Agency of Medicines, the Health Insurance Fund will wait for the Agency's response before making a decision. This usually also takes 30 days. If it takes longer, the Health Insurance Fund will make a decision as soon as possible after receiving the response from the State Agency of Medicines.

As a rule, the decision on exceptional reimbursement is valid for the entire duration of the treatment, so it is sufficient to apply once.

If the medicine is not authorized for sale and a digital prescription application(Opens in new tab) must be submitted to the State Agency of Medicines, the Health Insurance Fund will wait for the Agency's response before making a decision. This usually also takes 30 days. If it takes longer, the Health Insurance Fund will make a decision as soon as possible after receiving the response from the State Agency of Medicines.

As a rule, the decision on exceptional reimbursement is valid for the entire duration of the treatment, so it is sufficient to apply once.

If the medicine is not authorized for sale and a digital prescription application(Opens in new tab) must be submitted to the State Agency of Medicines, the Health Insurance Fund will wait for the Agency's response before making a decision. This usually also takes 30 days. If it takes longer, the Health Insurance Fund will make a decision as soon as possible after receiving the response from the State Agency of Medicines.

As a rule, the decision on exceptional reimbursement is valid for the entire duration of the treatment, so it is sufficient to apply once.

If the medicine is not authorized for sale and a digital prescription application(Opens in new tab) must be submitted to the State Agency of Medicines, the Health Insurance Fund will wait for the Agency's response before making a decision. This usually also takes 30 days. If it takes longer, the Health Insurance Fund will make a decision as soon as possible after receiving the response from the State Agency of Medicines.

As a rule, the decision on exceptional reimbursement is valid for the entire duration of the treatment, so it is sufficient to apply once.

Notification of the response to the application

The Health Insurance Fund will send the decision to you and your treating physician by encrypted e-mail. If you do not have e-mail or there are technical problems, the decision will be sent by registered mail to the postal address indicated in the application.

The notification will specify the exact name of the reimbursable medicine, the package code, the discount rate, and the compensation period. In the event of a negative decision, the reasons for refusing reimbursement will be explained.

The Health Insurance Fund will send the decision to you and your treating physician by encrypted e-mail. If you do not have e-mail or there are technical problems, the decision will be sent by registered mail to the postal address indicated in the application.

The notification will specify the exact name of the reimbursable medicine, the package code, the discount rate, and the compensation period. In the event of a negative decision, the reasons for refusing reimbursement will be explained.

Prescribing the medicine

After a positive decision on the exceptional reimbursement of the medicine, the treating physician may issue a discount prescription, which is done in the same way as for normally reimbursable discount medicines, but attention must be paid to the package code of the medicine.

In order for the exceptional discount to apply, the prescription must be written on the basis of the package, i.e. for the specific medicinal product for which the decision was made.

The 7-digit package code (e.g., 1733509) is indicated in the extract of the Health Insurance Fund's decision sent to the applicant and the attending physician.

If the doctor writes a prescription based on the active ingredient, the special discount does not apply immediately (the prescription will show a 0% discount), but only when the medicine is purchased at the pharmacy.

After a positive decision on the exceptional reimbursement of the medicine, the treating physician may issue a discount prescription, which is done in the same way as for normally reimbursable discount medicines, but attention must be paid to the package code of the medicine.

In order for the exceptional discount to apply, the prescription must be written on the basis of the package, i.e. for the specific medicinal product for which the decision was made.

The 7-digit package code (e.g., 1733509) is indicated in the extract of the Health Insurance Fund's decision sent to the applicant and the attending physician.

If the doctor writes a prescription based on the active ingredient, the special discount does not apply immediately (the prescription will show a 0% discount), but only when the medicine is purchased at the pharmacy.

NB! If you need a medicine with a different strength (e.g. 50 mg tablets instead of 30 mg), you do not need to submit a new application to the Health Insurance Fund for exceptional reimbursement of the medicine.

In this case, please call the Health Insurance Fund's information line at 669 6630 or write to erandkorras@tervisekassa.ee so that we can add the discount for this strength of medication.

NB! If you need a medicine with a different strength (e.g. 50 mg tablets instead of 30 mg), you do not need to submit a new application to the Health Insurance Fund for exceptional reimbursement of the medicine.

In this case, please call the Health Insurance Fund's information line at 669 6630 or write to erandkorras@tervisekassa.ee so that we can add the discount for this strength of medication.

NB! If you need a medicine with a different strength (e.g. 50 mg tablets instead of 30 mg), you do not need to submit a new application to the Health Insurance Fund for exceptional reimbursement of the medicine.

In this case, please call the Health Insurance Fund's information line at 669 6630 or write to erandkorras@tervisekassa.ee so that we can add the discount for this strength of medication.

NB! If you need a medicine with a different strength (e.g. 50 mg tablets instead of 30 mg), you do not need to submit a new application to the Health Insurance Fund for exceptional reimbursement of the medicine.

In this case, please call the Health Insurance Fund's information line at 669 6630 or write to erandkorras@tervisekassa.ee so that we can add the discount for this strength of medication.

Purchasing the medicine at a pharmacy

The medicine can be purchased from a pharmacy with an exceptional discount after a positive decision by the Health Insurance Fund and on the basis of a discount prescription issued by the attending physician. You and your attending physician will be notified of the decision by encrypted e-mail.

If the prescription is valid for:

90% discount, you only have to pay the prescription fee of €3.50 and 10% of the cost of the medicine at the pharmacy;
100% discount, you only have to pay the prescription fee of €3.50.

The medicine can be purchased from a pharmacy with an exceptional discount after a positive decision by the Health Insurance Fund and on the basis of a discount prescription issued by the attending physician. You and your attending physician will be notified of the decision by encrypted e-mail.

If the prescription is valid for:

90% discount, you only have to pay the prescription fee of €3.50 and 10% of the cost of the medicine at the pharmacy;
100% discount, you only have to pay the prescription fee of €3.50.

NB! Prescriptions purchased before the decision takes effect will not be reimbursed by the Health Insurance Fund.

Exceptional reimbursement of medications

Which medicines are reimbursed on an exceptional basis?

Automatic reimbursement of medications

Application for exceptional reimbursement of a drug

Processing of the application

Notification of the response to the application

Prescribing the medicine

Purchasing the medicine at a pharmacy

Important to know!

Exceptional reimbursement of medications

Which medicines are reimbursed on an exceptional basis?

Automatic reimbursement of medications

Application for exceptional reimbursement of a drugexpand_moreShow more

Processing of the applicationexpand_moreShow more

Notification of the response to the applicationexpand_moreShow more

Prescribing the medicineexpand_moreShow more

Purchasing the medicine at a pharmacyexpand_moreShow more

Important to know!

Application for exceptional reimbursement of a drug

Processing of the application

Notification of the response to the application

Prescribing the medicine

Purchasing the medicine at a pharmacy