Cover for pharmacy expenses for MUFACE mutual society members both in hospitals and pharmacies
Pharmaceutical benefits for MUFACE mutual society members include three situations of cover within the system of healthcare for civil servants. Here we will discuss the following issues:
- Dispensing of medicines in a pharmacy with a prescription
- Dispensing medicines in hospitals and healthcare centres charged to the Organisation
- Reimbursement for pharmacy expenses and dietary products
- Amount of this pharmaceutical benefit
This is the first of the pharmaceutical benefits and consists of the dispensing of medicines, healthcare and dietary products funded by the Spanish National Health System (NHS) in pharmacies. They must have been prescribed by a doctor using a MUFACE prescription book.
Some medications will need an approval. This must be acquired from a provincial service and the request will be accompanied by an annually updated medical report.
The mutual society member will have to pay for part of the requested medications through this pharmaceutical benefit. The amount will depend on the type of contribution made by the mutual society member:
- Normal contribution: MUFACE mutual society members must pay 30% of the price of the healthcare product.
- Reduced contribution: MUFACE mutual society members must pay 10% of the price of the medicine. The maximum limit that they will have to pay for each packet is 4.24 euros.
- Dietary products and blood glucose test strips will be exempt from this payment.
Prescription term of validity
The validity of the prescriptions in this pharmaceutical benefit vary according to type:
- General term: 10 calendar days from the date of the prescription or approval.
- Prescriptions for individually prepared hyposensitising extracts: 90 days due to their special characteristics.
The second pharmaceutical benefit includes the indication, prescription, and dispensation of medicines, healthcare and dietary products needed by hospitalised MUFACE mutual society members. This pharmaceutical benefit also encompasses medicines that, according to the agreement, the organisations should provided to outpatients.
This pharmaceutical benefit may be accessed by all MUFACE mutual society members and their beneficiaries whose medical care is covered by the National Health System or a medical insurance organisation. They will not have to contribute any financial payment.
This pharmaceutical benefit involves a series of situations in which the MUFACE mutual society member will be reimbursed for the costs of purchasing pharmaceuticals and dietary products that have public cover. These situations are the following:
- Medicines that are not marketed in Spain and that are acquired via competent Organisations.
- When the prescription has not been made on a MUFACE prescription for reasons of emergency or through having to see a different doctor.
- Exceptional and justified cases in which the prescription book could not be presented for the prescription.
- Reimbursement of the contributions paid for the dispensing of prescriptions of certain medicines or for particular pathologies (calcitonin in Paget's disease, HIV-AIDS patients, cystic fibrosis).
- Reimbursement of the contributions paid for the dispensing of prescriptions of certain medicines to patients with heterozygous familial hypercholesterolemia.
- Reimbursement for certain child inhalation chambers.
- Reimbursement of contributions for medicines derived from work-related accidents or diseases.
It also includes the special reimbursement of costs incurred through the Centres of the Organisations in the following cases:
- Research medicines used under "compassionate use".
- Hospital diagnosis drugs dispensed by the hospital pharmacy services to outpatients and external patients.
The amount of the third of the pharmaceutical benefits depends on each of these scenarios:
- Scenario A, B, and C: The difference between the amount paid by the mutual society member and the corresponding benefit will be paid.
- Scenario D and E: The mutual society member will receive the payment of the difference between the contribution paid and the reduced contribution.
- Scenario F: The MUFACE mutual society member will receive the reduced contribution.
- Scenario G: The mutual society member will be paid everything they have contributed.
- Special scenario A: They will be paid the price of the medicine.
- Special scenario B: Hospital diagnosis medicines without a coupon from the seal, the price of the medication will be paid. As for other medications, the corresponding contribution will be discounted.
The application model for this pharmaceutical benefit must be presented in the MUFACE provincial services or representative offices.
MUFACE members have access to other healthcare benefits. They are the following:
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