Subsidised and free prescriptions: what you actually pay at the pharmacy

On a subsidised prescription you don’t pay for the whole medicine, but often not zero either: reimbursement is 90% (sublist A), 50% (sublist B), or 100% (sublist C), and CAS (the national health insurance house) reimburses at the reference price, not the shelf price. That’s why, even for a “subsidised” medicine, you can end up with a difference to pay. Pensioners with low incomes get 90% on sublist B. Below we explain exactly what you pay and how to avoid surprises at the till.

The three levels of reimbursement

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

• Sublist A → 90% reimbursed. You pay 10% of the reference price.
• Sublist B → 50% reimbursed. You pay 50% of the reference price.
• Sublist C → 100% reimbursed (free prescription). Includes chronic diseases in national programmes, children, pregnant women, new mothers, and other special categories.

These percentages apply to the reference price, a detail that completely changes the final amount — we’ll come back to it in a moment.

Pensioners: 90% on sublist B, up to a cap

There is a special regime for pensioners. Pensioners with incomes below an annually set cap get 90% reimbursement for medicines on sublist B, instead of the 50% that applies to everyone else.

The figure quoted publicly for the monthly income cap is around 2,020 lei, but this threshold is updated periodically. Don’t treat it as a permanent value: check the threshold in force on cnas.ro or with the insurance house, because it directly determines how much you pay.

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 and the same form (the generics group). The 50%, 90%, or 100% reimbursement is calculated on this reference price, not on the price of the product you actually take.

The consequence:

• If you choose a medicine more expensive than the reference price, you pay the whole difference above it, on top of the non-reimbursed percentage.
• For the same “90% subsidised” medicine, you can pay a few lei or a few dozen lei, depending on the product chosen.

A simplified example

A medicine on sublist A (90%) has a reference price of 20 lei, but the brand-name product you ask for costs 35 lei.

• The reimbursement applies to 20 lei → the state covers 18 lei (90% of 20).
• You pay: 2 lei (the remaining 10% of the reference price) + 15 lei (the difference above the reference price) = 17 lei.

If you had taken the generic at 20 lei, you would have paid only 2 lei.

How to pay less at the till

• Ask the pharmacist for the generic or the version with the price 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.
• Check on the prescription the DCI (denumirea comună internațională, the international nonproprietary name, i.e. the active substance); the pharmacist can dispense any product with that DCI.
• If you are a pensioner with a low income, make sure the doctor ticked the 90% regime on sublist B.

Who prescribes it and how long the prescription is valid

The subsidised prescription is issued by the family doctor or by a specialist doctor who is under contract with CAS. It is issued electronically.

The validity periods differ:

• acute conditions: usually 24-48 hours from issue;
• chronic conditions: up to 30-90 days.

The exact deadline is written on the prescription; after it expires, you need a new prescription.

Which medicines are NOT subsidised

Not every medicine falls under the reimbursement system. These stay at the full price, paid out of pocket:

• medicines that are not on the list approved by HG 720/2008 (Government Decision 720/2008);
• food supplements and products without the status of a medicine;
• OTC medicines (dispensed without a prescription), generally;
• products prescribed outside the indications for which they are subsidised.

The fact that a substance has a subsidised version does not mean that all its doses or forms are subsidised. The list specifies exactly which concentrations and forms are covered, which is why the doctor chooses the prescription according to the list.

How to check whether a medicine is on the list

• Ask the doctor at the time of prescribing whether they are choosing a subsidised version.
• Ask the pharmacist to tell you which sublist it’s on (A, B, or C) and what the reference price is.
• Consult the official list of subsidised and free medicines, published and updated by CNAS on cnas.ro.

If you need a prescription or a review of your treatment, you can quickly find a family doctor in Cluj or another specialist in our directory.

Quick summary

• Reimbursement: 90% (A), 50% (B), 100% (C, free).
• Pensioners: 90% on sublist B, below an annually updated income cap (≈2,020 lei — to be confirmed on cnas.ro).
• The reference price is the basis of reimbursement; the difference above it you pay in full.
• Choose the generic close to the reference price to pay the minimum.

Sources

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