Continuing autoimmune and biologic treatment in Spain

Terms used

• Médico de familia — The médico de familia is your family doctor (GP) at the public health centre, who refers you to hospital specialists.
• Hospital de día — The hospital de día is the hospital day unit where you receive infusions and go home the same day.
• Visado — A visado is a prior authorisation from the health inspectorate that some medicines need before they can be dispensed.
• Mutua — A mutua is a mutual insurer, such as MUFACE for civil servants, that gives its members care outside the standard public route.

Key rules

• Referral: Your GP must refer you to the hospital specialist; you cannot book one directly.
• Bridge supply: Bring enough medicine from abroad to cover the weeks before hospital dispensing starts.
• Where you collect: Biologics come from the hospital pharmacy, not a normal pharmacy.
• Funding: If your drug is not funded for your condition, the specialist may switch you to a funded alternative or biosimilar.

The route in: GP first, then the hospital specialist

You cannot book a hospital specialist directly. Your médico de familia (GP) at your health centre refers you to the hospital outpatient clinic for your condition, such as rheumatology, gastroenterology, neurology or dermatology. Direct access without a referral is limited to emergencies.

The hospital or regional health service then sends your appointment by letter, SMS, app or phone, or you get it at the health centre. Waits run from weeks to several months, depending on your region and specialty. Each region publishes its waiting-list data.

Once the specialist follows you, they set your review appointments themselves. You do not need a new GP referral each time.

If you use private care or a mutua such as MUFACE, the route is different. Ask your insurer or mutua how to reach a specialist.

Cover the gap before the first visit

Getting a first appointment and starting hospital dispensing often takes weeks. Bring enough of your biologic from abroad to cover that time. When you see the GP, say you are on a biologic and ask for the quickest first visit the specialist can offer.

What to bring to the specialist

• Your health card or proof of entitlement, and your ID.
• Medical reports showing your current drug, dose and treatment dates.
• Your last prescription from abroad.

The specialist reviews your foreign reports and writes the Spanish prescription.

How the hospital pharmacy supplies your biologic

Biologics are hospital-use drugs. You do not buy them at a normal pharmacy. The hospital pharmacy checks the prescription and hands the medicine to you in person, usually every 1 to 3 months. Some hospitals offer home delivery. Practice varies by hospital, so ask yours.

Will your drug be approved?

A biologic you started abroad is usually continued if it is funded in Spain for your condition. If it is not, the specialist may switch you to a funded alternative or a biosimilar.

Some starts or switches need approval from the hospital's pharmacy committee. Some regions ask for extra regional approval. A few products need a visado, which is a prior authorisation from the health inspectorate. Ask the specialist at the first visit whether any of this applies to you, so it does not delay your first dispensing.

Where you get infusions or injections

Infusions are given in the hospital day unit (hospital de día), under nurse supervision. The unit books your slots at set intervals, and you usually get dates at your visit or by phone. Injectable (subcutaneous) biologics are self-injected at home, and the hospital shows you how. In some regions, home infusion or outpatient centres are available in specific cases.

If a dose is delayed or missed, see the "What if your treatment is interrupted mid-cycle?" section below. The checklist, timeline and FAQ below give the step order.

Timeline and deadlines

• Bring a supply of your biologic from abroad to cover the gap: before you move

• Get a GP referral to the hospital specialist: as soon as you are registered in the public system

• Ask the specialist for a quick first visit and have them review your foreign reports: when you receive your appointment, which can take weeks to several months

• Start hospital pharmacy dispensing with the specialist's prescription: often takes weeks after the first visit

Checklist

• Ask your médico de familia (GP) for a referral to the hospital specialty that treats your condition.

• Bring your health card or proof of entitlement, your ID and your medical reports showing the current drug, dose and dates.

• Bring your last prescription from abroad so the specialist can review it and prescribe.

• Bring a supply of your medicine from abroad to cover the weeks before hospital dispensing begins.

• Ask the specialist whether your biologic is funded for your condition or whether a funded alternative or biosimilar is likely.

• Ask the hospital day unit for your infusion slots, or learn how to self-inject at home if your biologic is injectable.

• Ask the hospital pharmacy how often you collect your medicine and whether home delivery is available.

What if your treatment is interrupted mid-cycle?

Call your treating unit as soon as you notice the missed dose, session or infusion. This is usually the day hospital (hospital de día) or the specialist clinic that gave you the treatment. Ask them to rebook and to tell you how to handle the next dose. Do not skip or double up on your own.

Who to contact

• Treating unit or day hospital: For rebooking and dosing advice. Contact numbers differ by hospital and region, so save the number for your unit now.
• Hospital pharmacy (farmacia hospitalaria): If the hospital supplies your medicine and the problem is supply, such as a delayed delivery or a missing pack, contact the pharmacy.
• Your GP or the 061 health line: In many regions they can give advice if you cannot reach your unit.
• Hospital emergency department (urgencias) or 112: Use these if you feel unwell or the situation is urgent, especially out of hours. 112 is the European emergency number.

If you have no Spanish treatment team yet

Go to the emergency department. It must treat urgent cases whatever your status. After triage, the doctors can admit you or refer you to the right specialist unit.

• Registered residents in the public system are treated free.
• EU/EEA visitors with a European Health Insurance Card are treated under the public system.
• Other visitors are charged or need to use travel insurance. Billing varies by region and hospital.

Bring your medical reports, a list of your medicines and your prescription, ideally translated, so the doctors can continue your treatment.

Frequently asked questions

Can I book a hospital specialist directly without seeing a GP?

No, in the public system you normally need a referral from your médico de familia (GP) to reach a hospital specialist. Direct access is limited to emergencies, and in some regions to gynaecology or ophthalmology through primary care pathways. Once a specialist follows you, they give you your review appointments.

What happens if my biologic is not funded in Spain for my condition?

If your biologic is not funded for your condition, the hospital specialist may switch you to a funded alternative or a biosimilar.

Where will I get my biologic infusions in Spain?

Infusions are given in the hospital day unit (hospital de día), with nurses supervising. The unit books your slots at set intervals and gives you appointments at your visit or by phone. Injectable biologics you give under the skin are self-injected at home.

How often do I collect biologics from the hospital pharmacy?

You usually collect them in person every 1 to 3 months. Some hospitals offer home delivery. The pharmacy validates each dispensing against the specialist's prescription.