How reimbursement of generic drugs works?

Thursday, 21 September 2023
In accordance with:
Le Département des Affaires Sociales et de la Santé [Department of Social Affairs and Health]
L’Ordre des Médecins de la Principauté de Monaco [The Order of Physicians of the Principality of Monaco]
Les Caisses Sociales de Monaco [The Social Funds of Monaco]

The Order of Pharmacists want to promote the use of generic medicines, and is committed to applying the regulations in force since 2020.
What is a generic drug?

Generic drugs have, for the vast majority of patients, the same effectiveness as branded drugs, with no more side effects, nor do they present a greater health risk since they are the same active compound.

To be to be marketable, the generic drug must contain the same quality and quantity of active ingredient as the brand-name drug.
Even if the two treatments (brand-name and generic) are identical in terms of their active ingredient, the carrier and prices may vary.

How does the reimbursement of medicines belonging to a generic group work? :

The brand-name medication is invoiced by the pharmacist and reimbursed on the basis of its price by CAMTI:

  • If for medical reasons linked to the patient's state of health, the doctor, dental surgeon or midwife indicates “non-substitutable” on the prescription.
  •  In the event that the pharmacist is unable to offer substitution with a generic medication.

When the brand-name medicine is dispensed at the patient's request without medical justification, the pharmacist invoices at the brand-name price, and reimbursement is based on the price of the generic medicine.
Since brand-name medications are sometimes more expensive than generics, the amount remaining payable by the patient after reimbursement by the CAMTI may, in this case, be greater.

Freedom to prescribe and deliver are thus fully preserved.
Any patient whose state of health justifies it is reimbursed for the delivery of a brand-name medicine on the basis of the price paid.