Subsidised medicines for pensioners: who gets 90%

Pensioners benefit from 90% coverage for the medicines on sublist B — double the usual 50% — if their monthly pension income is below a legally set ceiling. Above that ceiling, coverage returns to 50%. The figure circulated publicly for the threshold is around 2,010-2,020 lei/month, but it is updated periodically, so check the value in force on cnas.ro. Below we explain the sublists, the ceiling and why, even when “covered”, you can still be left with a difference to pay.

The rule in brief: 90% or 50% for pensioners

The medicine coverage system is set by Law 95/2006 and implemented through a government decision (the actual list of medicines). For pensioners, the essential point is this:

• Pensioner with income below the ceiling → 90% coverage on sublist B.
• Pensioner with income above the ceiling → 50% coverage on sublist B, like any other insured person.

The increased 90% rate is granted specifically to pensioners with low incomes and is the reason why many pensioners pay only a small part of the price of chronic medicines. The 40% difference above the usual 50% coverage is borne by the National Unique Health Social Insurance Fund (FNUASS — Fondul național unic de asigurări sociale de sănătate).

What the income ceiling is and how much it is

The ceiling is a monthly income threshold below which the pensioner qualifies for the 90% coverage. When setting it, pension income is usually taken into account.

The value widely cited in the press and in the insurance houses’ communications is approximately 2,010-2,020 lei/month, but:

• the threshold changes periodically through legal acts;
• do not treat it as a permanent value;
• check the threshold in force on cnas.ro or with the county insurance house before making a final calculation.

Whether you pay 10% or 50% of the medicine’s reference price depends directly on this threshold — an important difference for a monthly chronic treatment.

Watch out for the monthly value limit

For pensioners, the increased 90% coverage on sublist B is usually granted within a monthly value set by the implementing rules. Above that value, the general rule may apply. This is another detail worth confirming on cnas.ro, because it changes the final sum for more expensive prescriptions.

The three sublists: A, B, C

Subsidised medicines are organised into sublists, and the sublist decides the percentage borne by the state:

• Sublist A → 90% covered for all insured people. You pay 10% of the reference price.
• Sublist B → 50% covered for the ordinary insured person, but 90% for pensioners with income below the ceiling.
• Sublist C → 100% covered (free prescription). It covers chronic diseases under national health programmes (for example diabetes, oncology, rare diseases), children, pregnant women, post-partum women and other special categories provided by law.

For a chronic pensioner, the most common medicines (blood pressure, cholesterol, heart conditions) are typically on sublist B, exactly where the 90% regime makes the difference.

The “reference price” trap

This is where most patients lose money, without understanding why.

CAS does not reimburse at the shelf price, but at a “reference price” — usually the price of the cheapest medicine with the same active substance (DCI) and the same pharmaceutical form, within a group of equivalents. The 50%, 90% or 100% is calculated on this reference price, not on the price of the product you actually take.

The consequence for a pensioner:

• If you choose a medicine that is more expensive than the reference price, you pay the full difference above it, in addition to the uncovered percentage.
• For the same “90% covered” medicine, you can pay a few lei or a few tens of lei, depending on the product chosen.

Simplified example

A medicine on sublist B has a reference price of 40 lei, and you are a pensioner below the ceiling (so you have 90%). If the branded product you ask for costs 60 lei:

• The 90% coverage applies to 40 lei → the state bears 36 lei.
• You pay: 4 lei (10% of the reference price) + 20 lei (the difference above the reference price) = 24 lei.

If you had taken the generic at 40 lei, you would have paid only 4 lei. Choosing the product matters more than the percentage.

How a pensioner pays as little as possible

• Ask for the generic or the variant closest to the reference price, with the same therapeutic effect.
• Ask how much is left to pay before the pharmacist dispenses — you have the right to choose another product from the same group.
• Make sure the doctor has ticked the pensioner regime (90% on sublist B), if you qualify.
• Check the DCI (the active substance) on the prescription; the pharmacist can dispense any product with that DCI.

What is not covered

They remain at the full price, paid out of pocket:

• medicines that do not appear on the list approved by government decision;
• food supplements and products without medicine status;
• OTC medicines (over the counter, without prescription), in general;
• products prescribed outside the indications for which they are covered.

Quick summary

• Pensioner below the ceiling → 90% on sublist B; above the ceiling → 50%.
• The ceiling (≈2,010-2,020 lei) is updated — confirm it on cnas.ro.
• The sublists: A (90%), B (50% / 90% for pensioners), C (100%, free).
• The reference price is the basis for coverage; the difference above it you pay in full.

Do you need a prescription or a treatment review? You can quickly find a family doctor in Cluj in our directory, and we have written at length about what you actually pay at the counter in the guide The subsidised prescription.

Sources

• Law 95/2006 on the reform of the health field — legislatie.just.ro
• HG 720/2008 approving the list of medicines available to the insured, with or without a personal contribution — legislatie.just.ro
• Casa Națională de Asigurări de Sănătate (the National Health Insurance House) — the list of subsidised and free medicines, the ceiling for pensioners — cnas.ro
• Casa de Asigurări de Sănătate Cluj (the Cluj Health Insurance House) — casjcluj.ro