What to do when Spain won't continue a treatment that was working

Terms used

• Tarjeta sanitaria — The tarjeta sanitaria is your public health card, used to book appointments and change doctor.
• Recurso de alzada — The recurso de alzada is an administrative appeal to a higher authority against a decision, such as a funding refusal.
• Segunda opinión — The segunda opinión is a second medical opinion from another doctor, a right regulated only in some regions.
• Medicamento extranjero — The medicamento extranjero is a medicine not authorised in Spain that can be obtained for an individual patient with special approval.

Key rules

• Your options: You can ask for the reason, a second opinion, a different doctor or a formal review; accepting an unexplained change is not your only choice.
• Appeal deadline: A funding refusal can be appealed normally within one month, so act as soon as you get the written decision.
• Unauthorised drugs: A medicine not authorised in Spain needs special access requested through your doctor and hospital pharmacy.
• Regional rules: Second opinions, doctor changes and complaint deadlines differ by region.

You do not have to accept an unexplained change

A "no" or a switch to a different drug is a decision you can ask about, question and, in the public system, formally challenge. Start by asking for the reason. Then use the routes below.

Why a Spanish doctor may say no

These are the common reasons:

• The drug is not authorised in Spain, or the public system does not fund it.
• A cheaper equivalent with the same active ingredient exists. Spanish doctors normally prescribe by active ingredient, not brand.
• The diagnosis or evidence does not match Spanish clinical guidelines.
• The exact dose, brand or combination is not sold in Spain.
• It is a hospital-only or restricted drug that needs committee approval.
• Your foreign records or tests are incomplete, so they want to repeat them.
• Safety concerns, such as interactions with other medicines.

Private doctors have more freedom, but the same legal limits on unauthorised drugs apply.

Step 1: Ask for the reason and the alternatives

Ask what exactly was decided: a refusal, a delay or a change. Ask whether the reason is clinical or about funding, which tests or papers could change the decision, and what the alternatives are with their risks. Ask for the decision in writing in a clinical report (informe). The checklist below lists the questions and the papers to gather.

Step 2: Change doctor or get a second opinion

In the public system you can ask for a change of family doctor at your health centre's admissions desk, or through your region's online health portal or app. You usually need your tarjeta sanitaria. Changes are normally granted if the new doctor has capacity, and some regions limit how often you can change, often once a year without a reason.

Specialists are normally reached by referral from your family doctor. Some regions let you choose your hospital or specialist, and some regulate the right to a segunda opinión, mostly for serious conditions. Check your regional health service for the rules. Private insurance and mutualidades such as MUFACE have their own provider lists.

Step 3: Complain about a clinical decision

If talking does not work, go to the hospital's patient service (Servicio de Atención al Paciente). You can file a formal complaint or suggestion (reclamación or queja). It is answered in writing within a regional deadline. If that goes nowhere, you can take it to the regional ombudsman or the national Defensor del Pueblo.

Step 4: Challenge a funding refusal

A refusal to fund a medicine is usually a written decision of the hospital or regional health service. Do this:

1. Ask your treating doctor and the hospital's pharmacy committee to review it.
2. File a complaint or an administrative appeal (recurso de alzada) with the regional health authority, normally within one month.
3. If that fails, go to the contentious-administrative courts, generally within two months of the decision.

The exact deadline and body are in the written decision, so read it as soon as you get it. Whether a medicine is publicly funded at all is decided nationally by the Ministry of Health. That decision can also be challenged administratively and in court. Free legal aid may be available.

If your medicine is not sold in Spain

Search for it by brand name or active ingredient on CIMA, the medicines database of the Spanish medicines agency (AEMPS). If it is not authorised in Spain, it can only come as a medicamento extranjero or through compassionate use or special access. Your treating doctor and the hospital pharmacy make the request to AEMPS, which can authorise individual patients. A Spanish product with the same active ingredient may be offered instead. Ask whether it suits you.

Keeping your supply going meanwhile

You can bring medicine for personal use. For non-EU arrivals, bring only what the treatment needs, generally up to about three months. Keep the original packaging and carry a prescription or doctor's letter naming the active ingredient and dose. Medicines with narcotics or psychotropics need extra papers. Ordering medicine by post from abroad is more restricted. Once in Spain, you need a Spanish prescription to continue. The documents and warning blocks below give the details.

Choosing between options

What should you do when your Spanish doctor won't continue your treatment?

• Ask for the reason and an alternative: The reason is unclear or a Spanish equivalent with the same active ingredient may work for you.

• Change doctor or ask for a second opinion: You disagree with the clinical judgement. A change of family doctor is generally allowed in the public system; second opinions are regulated only in some regions and cases.

• Challenge a funding refusal: The refusal is a written decision about paying for the medicine. Ask for a review by your doctor and the hospital's pharmacy committee, then file a complaint or appeal.

• Ask for special access to a foreign medicine: The medicine is not authorised in Spain and no equivalent suits you. Your doctor and hospital pharmacy make the request to the medicines agency.

Start with the reason: if it is clinical, change doctor or ask for a second opinion; if it is about funding, appeal the written decision; if the drug is not authorised, ask for special access.

Timeline and deadlines

• File a complaint or an administrative appeal (recurso de alzada) with the regional health authority: normally within one month of the decision

• Get the answer to a formal complaint about a clinical decision: in writing, within your region's deadline

• Bring a bridge supply of your medicine, if you need one, with your prescription or doctor's letter: when you travel, for generally up to about three months of treatment

• Use a Schengen certificate for medicines with narcotics or psychotropics when travelling within the Schengen area: for stays of up to 30 days

Documents you need

• Your medicine in its original packaging, for personal use only and limited to what the treatment needs (generally up to about three months for non-EU arrivals).

• Your prescription or a letter from your doctor naming the active ingredient and the dose.

• For medicines with narcotics or psychotropics: a certificate under the Schengen rules if you travel within the Schengen area for up to 30 days, or authorisation from the medicines agency (AEMPS).

• A Spanish prescription, needed once you are in Spain to keep the supply going.

Preparing your case when Spain won't continue your treatment

Preparing your case

• Ask your Spanish doctor what exactly was decided (refusal, delay or change) and whether the reason is clinical, a protocol or formulary rule, or cost.

• Ask which documents or tests would change the decision, and what alternatives exist with their risks and benefits.

• Ask for the decision in writing in a clinical report (informe), and for a copy of your records, which you have a legal right to.

• Ask who made the decision, whether a committee or a second opinion (segunda opinión) is available, and who follows your treatment in the meantime.

• Ask how to appeal, through which service (such as the Servicio de Atención al Paciente, the patient care service, or a formal reclamación complaint) and within what deadline.

• Get a recent clinical report (informe clínico) from your treating specialist stating your diagnosis, the date of diagnosis and your current status.

• Collect hospital discharge reports (informes de alta) and results of relevant tests, such as blood work, imaging, biopsy or pathology and genetic tests.

• List your current prescriptions with the generic name of the active ingredient, dose and duration.

• Write a treatment history listing each drug tried, the dates, your response and any side effects, plus your allergies, other conditions and other medications.

• Gather proof of why alternative drugs are unsuitable if you are asking for a drug to be approved or reviewed.

• Bring your identity and health card details and any previous Spanish records.

• Ask the hospital or committee whether English reports are enough or whether they want a translation, before paying for a sworn translation (traducción jurada). Sworn translations are usually needed only for formal procedures such as disability assessments, insurance claims, court cases or reimbursement.

• Check with your region's health service whether you qualify for a public second opinion. It usually covers serious illnesses such as cancer, rare diseases or major surgery decisions, and each region sets its own list.

• If you get a private or foreign second opinion, hand it to your public doctor as clinical information. They may agree with it but do not have to follow it, and funding is not automatic.

What to watch out for

• Accepting a change without hearing the reason: A doctor may change or decline a treatment for reasons you can check: the drug is not authorised or funded in Spain, a cheaper generic exists, the dose or brand is unavailable, your records are incomplete, or there is a safety concern. If you do not ask, you cannot tell whether the reason is clinical or only about supply. Ask which reason applies and ask for it in writing. If your records are incomplete, bring the missing reports.

• Missing the appeal deadline: A refusal to fund a medicine is usually a written decision, and the appeal window is short: normally one month for an administrative appeal and generally two months for the courts. Check the deadline in the written decision as soon as you receive it and file before it runs out.

• Expecting a restricted or unauthorised drug to be simply prescribed: Hospital-only drugs need committee approval, and off-label or unauthorised drugs need special authorisation, so a refusal may be only a first step. Ask your doctor whether a committee review or a special-access request is possible.

Frequently asked questions

Can I ask for a different doctor if mine won't continue my treatment?

Yes, in the public system you can ask for a change of family doctor at your health centre's admissions desk or through your regional health portal, usually with your health card.

How can I find out whether my medicine is sold in Spain?

Search for your medicine by brand name or active ingredient on CIMA, the online medicines database of the Spanish medicines agency (AEMPS). If it is not authorised, your doctor and hospital pharmacy can request it as a foreign medicine through the agency, or offer a Spanish equivalent with the same active ingredient.

Can I bring my own supply of medicine into Spain while I sort this out?

Yes, you can bring medicine for personal use, but non-EU arrivals are usually limited to the amount needed for the treatment, generally up to about three months. Keep it in original packaging and carry the prescription or a doctor's letter naming the active ingredient and dose. Medicines with narcotics or psychotropics need extra documents, so check with the medicines agency or customs before you travel.

Who do I turn to if the complaint to my hospital goes nowhere?

You can take it to the regional ombudsman, the independent body that reviews complaints about public services. For a formal decision you can also file an administrative appeal and, after that, go to the courts.