Those exempt from pharmaceutical co-payment also for orthoprosthetics

He Ministry of Health has published this Friday for hearing and public information a draft of Royal Decree (RD) which will automatically establish that people already exempt from co-payment in outpatient pharmaceutical services will also be exempt from copayment for orthoprosthetic products.

As explained by Health, this will benefit people currently exempt from co-payment on medications, for example, pensioners with low incomes, people with disabilities or groups in situations of special protection.

In this way, the Ministry seeks to reinforce the coherence of the health system and advance social equity, avoiding differences in treatment between benefits and facilitating access to essential products for the population’s quality of life. In this sense, he specified that there are communities, such as the Valencian Community and Castilla y León, which already have implemented aid for orthoprosthetic co-payment for the aforementioned groups.

This measure has been included in the draft Royal Decree that regulates the right to health protection for people living in Spain without legal residence and extends the right to health care to Spaniards living abroad during their temporary trips to Spain, both funded by public funds.

To this end, the text incorporates the modification of article 9 and the second additional provision of Royal Decree 1506/2012, of November 2, which regulates the common supplementary portfolio of orthoprosthetic benefits of the National Health System and establishes the bases for establishing the maximum financing amounts for orthoprosthetic benefits.

Budget impact

The Ministry has calculated that the equalization of the groups exempt from the pharmaceutical and orthoprosthetic contribution will mean a budgetary impact of 2,261,582 euros per year for the Autonomous Communities and for the National Institute of Health Management (INGESA).

To calculate this impact, Health has taken into account Royal Decree 1506/2012, which establishes the bases of the orthoprosthetic copayment, from which a large part of the product catalog is exempt, such as external prostheses and wheelchairs. Meanwhile, the co-payment for orthoses and special orthoprostheses, depending on the products, can be 0, 12 or 30 euros.

Likewise, it has analyzed the data provided in the 2020-2021 period by the Department of Health of the Generalitat Valenciana, which since 2016 has subsidized both pharmaceutical and orthoprosthetic contributions to minors with a recognized degree of disability equal to or greater than 33 percent and to the elderly with minors with a recognized degree of disability equal to or greater than 65 percent.

From this information he has estimated that there is 1.10 percent of people with orthoprosthesis dispensation, that the number of prescriptions per person is 1.4 and that the average contribution price for dispensing (general population) is 20 euros.

On the other hand, according to the report on contribution to the payment of prescription drugs in the SNS of the Ministry of Health, it has been pointed out that, in January 2024, the number of insured people and their beneficiaries exempt from pharmaceutical contributions was 7,342,799 people.

With this, it has been estimated that, of the people exempt from co-payment, 80,771 will have some form of orthoprosthetic products dispensed, raising the number of prescriptions in this group to 113,079.