Buying medicinal products and foodstuffs for special medical purposes in another EU country

From funds of the compulsory health insurance in Slovenia, all insured persons have the right to coverage of costs of medicinal products and foodstuffs for special medical purposes (hereinafter ‘medicinal products’) which are on the positive or intermediate list, as well as magisterial preparations from the List of magisterial preparations, prescribed by an accredited physician.

More on your right to medicinal products and foodstuffs for special medical purposes

Reimbursement of costs of medicinal products

You can claim reimbursement of costs of a medicinal product you purchased abroad for medicinal products you are entitled to under compulsory health insurance and which are available on the Slovenian market, but you purchased it in another EU Member State or in Slovenia on the basis of a EU prescription - you purchased it abroad because you cannot get it in Slovenia.

You can claim reimbursement of purchase costs of a medicinal product with:

• a green prescription in electronic or paper form, signed by an accredited physician in Slovenia,
• a prescription, prescribed by a healthcare professional in another EU Member State.

To purchase a medicinal product abroad, the doctor must issue you a green prescription on paper (and not a white one, which you have to pay for yourself), as we do not yet have a system to digitally exchange documents with other countries.

When may you request a green prescription on a paper document from a licensed doctor?

You may request a green prescription on paper from a doctor:
•    when a prescription is issued without an electronic version,
•    as a replacement on paper, if it had already been issued in electronic form, but the medicinal product has not yet been administered in full.  

When the replacement green prescription on paper is issued, the doctor will annul the electronic prescription. The electronic prescription is annulled regardless whether it can be renewed or not and whether the medicinal product has not been yet administered in full.

Where and how to claim reimbursement of the costs of medicinal products purchased abroad?

You can claim reimbursement of costs of a medicinal product you purchased abroad with an application which you submit to the regional unit or office of the ZZZS by sending it by mail or submitting it in person.

Reimbursement of costs of medicinal products, purchased in an EU Member State

You are entitled to reimbursement of the purchase costs of a medicinal product, if you are entitled to the medicinal product under the compulsory health insurance in Slovenia and it is available on the Slovenian market, yet you purchased it in another EU Member State or in Slovenia based on an EU prescription issued in accordance with relevant regulations, for an appropriate quantity which may be issued in a certain time period and in accordance with the time period, within which the prescription must be submitted to a pharmacy.

Deadline for purchasing the medicinal product after the prescription date

To be eligible for reimbursement, you must purchase the medicinal product within the validity period of the prescription or in accordance with regulations for obtaining medicinal products in a Slovenian pharmacy (second or third paragraph of Article 204 of the Regulations) or within the validity period of a renewable prescription. The validity period of a prescription applies for green prescriptions as well as EU prescriptions.

If you are claiming reimbursement based on a replacement green prescription on a paper document, the validity period for purchasing medicinal products and foodstuffs in another EU Member State begins on the date the electronic prescription was issued, and not on the date the replacement green prescription on a paper documents was issued, which is prescribed instead of an electronic prescription.

Application and annexes

If you want to claim reimbursement for the cost of a medicinal product you purchased abroad, submit an application with the following documents:

• application - can be a letter or form with your data or the data of the person for which you are claiming reimbursement, the purpose of the application,
• original or a copy of the prescription or EU prescription,
• if you are claiming reimbursement of costs of the medicinal product on the basis of an electronic prescription, state so in your application,
• original invoice of the pharmacy, and
• if you are claiming reimbursement on the basis of an EU prescription, you must also submit medical records with a diagnosis and the opinion of the doctor who issued the EU prescription; the ZZZS may also request other documents of you, necessary for the decision-making process,
• data on your bank account.

If the EU prescription or other documents are submitted to the ZZZS in a foreign language which the ZZZS official does not understand, you are obliged to submit a translation in the Slovenian language at your own cost upon request of the ZZZS.

Application form for reimbursement of purchase costs of a medicinal product:
Application for reimbursement of purchase costs of a medicinal product

Amount of cost reimbursement for medicinal products

Insured persons are entitled to claim reimbursement of the costs of medicinal products in the amount of their price and to a percentage which the ZZZS would cover if it were issued in Slovenia, but not exceeding the actual costs of the medicinal product.

Reimbursement of costs of medicinal products and foodstuffs purchased abroad because they are unavailable in Slovenia due to supply disruptions

You are entitled to reimbursement of costs of a medicinal product purchased abroad, if the product is unavailable on the Slovenian market.
Insured persons may claim reimbursement of costs of a medicinal product on the basis of a green prescription or an EU prescription if two conditions are met:

1. condition: a Slovenian pharmacy issues a statement that they are unable to provide the medicinal product due to a supply disruption and cannot replace it with another medicinal product, or a similar statement regarding the relevant foodstuff.
2. condition: you must purchase the medicinal product no later than 14 days after the deadline for getting the medicinal product at a Slovenian pharmacy expires or 14 days after the validity of the renewable prescription expires.

A pharmacy will not issue a statement on the unavailability of a medicinal product when it can be substituted with another medicinal product from a group of interchangeable medicinal products or a therapeutic group of medicinal products, if the prescription or EU prescription does not bear the mark “do not substitute!”, unless the supply of all medicinal products of such a group on the Slovenian market is disrupted during the validity period of the prescription.

If the statement on the unavailability is not issued before you purchase the medicinal product abroad, it will be obtained by a ZZZS official in the decision-making process on the claim for reimbursement of costs of the medicinal product.

Deadline for purchasing the medicinal product after the prescription date

To be eligible to claim reimbursement of purchase costs of a medicinal product you must purchase the medicinal product abroad no later than 14 days after the validity period of the prescription, meaning no later than 14 days after the deadline to pick up the medicinal product at a Slovenian pharmacy expires or 14 days after the validity period of the renewable prescription expires. The deadline to purchase medicinal products and foodstuffs abroad begins when the electronic prescription is issued, not on the date the replacement green prescription on a paper document is issued, which is prescribed instead of an electronic prescription.

If you can pick up the medicinal product again at a Slovenian pharmacy within the specified deadline, you may also pick it up (and not purchase it) at a Slovenian pharmacy. To be able to pick up the medicinal product within this later 14-day deadline, you must submit a statement on the unavailability of the product to the pharmacy, if it was issued in paper form (as a separate document). The pharmacy keeps this statement and encloses it to the prescription, based on which the medicinal product is issued within this later deadline.

Application and annexes

If you want to claim reimbursement of the costs of a medicinal product you purchased abroad, submit an application with the following documents:

• application - can be a letter or form with your data or the data of the insured person for which you claim reimbursement, the purpose of the application;
• statement of the pharmacy on the unavailability of the medicinal product on the market; if this statement is not issued before you purchase the medicinal product abroad, it will be obtained by a ZZZS official;
• statement of the insured person that he/she claims reimbursement of costs of the medicinal product due to a supply disruption, if the statement on the unavailability of the medicinal product is not issued in paper form;
• original or copy of the EU prescription or prescription based on which the medicinal product was purchased;
• original invoice from the pharmacy for the purchased medicinal products and
• data on your bank account.

Application form for reimbursement of purchase costs of a medicinal product:
Application for reimbursement of purchase costs of a medicinal product

Amount of cost reimbursement for a medicinal product purchased abroad

Insured persons are entitled to a reimbursement of purchase costs of the medicinal product in the amount of the actual cost of the product in the country in which it has been purchased, to a percentage the ZZZS would cover, had the medicinal product been issued in Slovenia.

Information on ZZZS prescriptions and EU prescriptions

ZZZS prescription

This prescription presents a ZZZS document for prescribing medicinal products and foodstuffs the ZZZS classifies on a positive or interim list, and magisterial preparations from the List of prescription magisterial preparations prescribed to an insured person by a licensed doctor in Slovenia. Only one medicinal product or foodstuff may be prescribed with one prescription and only for one person.

The prescription consists of an administrative and medical part. The administrative part of the prescription entails data on the user, the doctor, the person who pays for the medicinal product and other relevant data. The medical part of the prescription entails the name, form, strength and quantity of the medicinal product, the dosage, method of application and eventual other relevant data. The prescription also includes identification data of the healthcare professional who prescribed the document (by stating his personal name, professional qualification, direct contact data - email and telephone number or fax number).

Detailed instructions on how to fill out the prescription document are provided in Instructions for filling out the document Prescription and the document Prescription for personal use

Document sample

EU prescription

EU prescription is a paper document for prescribing medicinal products and foodstuffs that a healthcare professional in another EU Member State, who is authorised to prescribe such products or foodstuffs, prescribes to an insured person.