Prescription copayments (copago) and prices

It is for anyone thinking about, planning or carrying out a move to Spain. It covers the income-based tiers, who pays less or nothing, medicines that are not covered at all, and how generics and regulated prices change your bill. It does not cover private insurance premiums, the routes to health-system entitlement, or private doctor visit prices.

Start with "How the prescription copayment (copago) works". It explains the percentage system that every other page builds on. After that, go to the page that matches your situation, such as a new resident, a retiree, a family or a short-stay visitor.

Key rules

• Price basis: The percentage is charged on the pharmacy price, and if a medicine costs more than its reference price you also pay the difference.
• Pensioner rate: Pensioners pay 10% of the price of financed medicines, with a monthly cap that depends on income.
• Working-age rates: Working-age people pay 40% of the pharmacy price below 18,000 euros a year, 50% from 18,000 to under 100,000 euros, and 60% at 100,000 euros or more.
• Pensioners: Pensioners on TSI 005 pay 10%, with a monthly cap that depends on income.
• No copayment: TSI 001 and TSI 006 pay nothing.
• Default tier: With no Spanish income data you most likely start in TSI 002, paying 40%, though some regions use TSI 003.

Prescription copayments (copago) and prices: the whole process, step by step

• Learn how the percentage system works (How the prescription copayment (copago) works): before your first pharmacy visit

• Find your starting tier, or your pensioner rate if you are a retiree (Which copayment tier you start in as a new resident; Prescription costs for retirees, pensioners and S1 holders): when you register and get your health card

• Check whether you or your family pay nothing or less, or share a family rate (Who pays nothing or less for prescriptions; How the copayment works for your spouse and children): before you collect your first prescriptions

• Check whether a medicine is financed and what the pharmacist may swap (When your prescription is not covered; Why the pharmacist gave you a different box): at the pharmacy, before you pay

• Your tier is reviewed once a year, once the tax data for the reference year is available: normally with changes in the middle of the year

• Expect an update if your situation changes, such as retirement or a change of benefit: during the year, as the change is passed on through social security

Check the current update timing with your regional health service.

Documents you may need

Identity and residence

• Your foreigner identity card — Who pays nothing or less for prescriptions (aportación reducida)
• Proof of residence — Who pays nothing or less for prescriptions (aportación reducida)

Income and work

• Proof of the income or benefit that justifies the exemption or lower rate — Who pays nothing or less for prescriptions (aportación reducida)
• Your latest Spanish income tax return — Which copayment tier you start in as a new resident
• Proof of your foreign pension — Prescription costs for retirees, pensioners and S1 holders

Other documents

• Your health card
• A prescription from a doctor in the Spanish public system — Medicine costs on a short stay with an EHIC or GHIC

Prescription copayments (copago) and prices: questions that cross several articles

Which income decides my copayment tier?

Your tier is based on your total taxable income (base imponible) in the income tax return from two tax years back, supplied by the tax agency. Pensioner status and benefits come from social security. Read How the prescription copayment (copago) works, and Which copayment tier you start in as a new resident if you have no Spanish tax history.

When does my copayment tier change during the year?

Your tier is reviewed once a year after the tax data is available, normally with changes in the middle of the year. It can also change when your situation changes, such as retirement or a new benefit. See Prescription costs for retirees, pensioners and S1 holders if that applies to you.

Is the copayment charged on the pharmacy price or the reference price?

The percentage is charged on the pharmacy price, including IVA (sales tax). If the medicine costs more than its reference price, you also pay the difference. For example, a 10-euro medicine at 40% costs you 4 euros. Read Why the pharmacist gave you a different box (genéricos) for more.

How do I match a medicine from home to a Spanish one?

Find the active ingredient (principio activo), strength and form on your box, because brand names differ between countries. Search that ingredient in the Spanish medicines database (CIMA), or ask the pharmacist. Read Why the pharmacist gave you a different box (genéricos) and Are medicines cheaper in Spain than at home?