Prescription copayments (copago) and pricesArticle 1 of 9 · 5 min read
How the prescription copayment (copago) works
Explains how the percentage you pay for a financed medicine in Spain depends on your income and status, what the TSI codes mean, and how to work out a charge before you reach the pharmacy counter. For anyone covered by the public health system.
Key rules
- Pensioners: Pensioners on TSI 005 pay 10%, with a monthly cap that depends on income.
- No copayment: TSI 001 and TSI 006 pay nothing.
- Your code: Your TSI code is on your health card, though layouts vary by region.
- Hospital stays: Medicines given during a hospital stay carry no copayment.
The short version
You pay a percentage of the pharmacy price of a financed medicine. The percentage depends on your income and your situation, and it is stored as a TSI code on your health card. Find your code, match it to the percentage, and you can predict the charge.
The percentages by TSI code
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. The income used is your annual taxable income.
The codes are:
- TSI 001: you pay nothing. This covers people receiving social integration income, non-contributory pensions or unemployment subsidies, and some others.
- TSI 002: 40%.
- TSI 003: 50%.
- TSI 004: 60%.
- TSI 005: 10%, for pensioners. Your monthly payment is capped, and the cap depends on your income band.
- TSI 006: you pay nothing. This covers people with work-accident or occupational-disease cover and some other special groups.
The table below shows the codes side by side. Regions may add their own exemptions on top of these national rates.
How to work out the charge
The percentage is charged on the pharmacy retail price, VAT included. For example, a 10-euro medicine at 40% costs you 4 euros.
If a medicine costs more than its reference price, you also pay the difference. Ask the pharmacist whether a cheaper equivalent exists.
Where to find your TSI code
Your code is on your tarjeta sanitaria individual, the health card issued by your regional health service. It usually appears as TSI 001 to TSI 006 on the front or in the card data. Layouts differ by region, and in some regions the code only shows in the electronic prescription system. If you cannot see it, ask at your health centre or your regional health service.
When your code changes
Your code is reviewed once a year, after the tax data for the reference year is available. It is also updated when your situation changes, for example when you retire or change benefit. Check the current timing with your regional health service.
Hospital stays
Medicines you are given during a hospital stay carry no copayment. Copayment applies to outpatient prescriptions collected at a pharmacy. In some cases it also applies to outpatient medicines dispensed by a hospital pharmacy.
If something looks wrong
Health is run by the region where you live. If the percentage at the pharmacy does not match your code, start with your regional health service's website or your health centre. Your town hall can also tell you what applies. Reforms to the copayment have been discussed, so check with the Ministry of Health or your regional service whether anything has changed.
Copayment tiers (TSI codes) side by side
| Code | Who it applies to | You pay | Monthly cap |
|---|---|---|---|
| TSI 001 | People receiving social integration income, non-contributory pensions or unemployment subsidies, and some other groups | 0% | None, you pay nothing |
| TSI 002 | Working-age people earning under 18,000 euros a year | 40% | None |
| TSI 003 | Working-age people earning 18,000 to under 100,000 euros a year | 50% | None |
| TSI 004 | Working-age people earning 100,000 euros or more a year | 60% | None |
| TSI 005 | Pensioners earning under 18,000 euros a year | 10% | 8.14 euros |
| TSI 005 | Pensioners earning 18,000 to under 100,000 euros a year | 10% | 18.32 euros |
| TSI 005 | Pensioners earning 100,000 euros or more a year | 10% | 61.75 euros |
| TSI 006 | People with work-accident or occupational-disease cover, and some other special groups | 0% | None, you pay nothing |
| Mutualidad (MUFACE, ISFAS, MUGEJU) | Members and beneficiaries | Same as the tiers above: 40% for active workers, 10% for pensioners, 60% for higher incomes | Pensioners have the same monthly caps as TSI 005 |
- Medicines for chronic or serious illnesses: Medicines on the Ministry of Health's list for chronic or serious illnesses carry a reduced rate of 10%. This is separate from the income tiers and the pensioner tier, and it has its own lower monthly cap of 4.52 euros per medicine.
- Mutualidad refunds: Mutualidad members pay the same percentages, but refunds follow each mutualidad's own rules.
- Regions: Regions may add their own exemptions.
- Caps: The government revises the caps from time to time. Check the current figures with the Ministry of Health, or with your mutualidad if you belong to one.
Timeline and deadlines
When your percentage changes
-
Your percentage is reviewed once a year, after the tax data for the reference year is available: Once a year, normally with changes in the middle of the year
-
Your percentage is updated when your situation changes, for example when you retire or change benefit: During the year, when the change is registered; status changes can arrive through the INSS, Spain's social security institute
-
Ask your regional health service which percentage applies to you now: If your pharmacy charges a percentage that looks wrong after a change
Copayment quick answers for special situations
Do I pay a copayment on over-the-counter medicines?
No, over-the-counter medicines bought without a prescription carry no copayment because you pay the full price. The public health system does not fund them. Copayment only applies to funded medicines dispensed on an official prescription.
Which tier do I get when I have just registered and have no Spanish tax data?
You are generally given the working-age tier TSI 002, which is 40%, until income data arrives. Some regions start new residents on TSI 003 instead. Your health card or registration papers show the code you were given.
Do MUFACE, ISFAS and MUGEJU members pay the same copayment as everyone else?
Yes, mutualidad members pay the same percentages as the public system, but refunds follow each mutualidad's own rules. You get a prescription from your chosen provider and show your mutualidad card at any pharmacy. The pharmacy charges your share on the spot and the mutualidad pays the rest.
More in Prescription copayments (copago) and prices
- Which copayment tier you start in as a new resident
- Prescription costs for retirees, pensioners and S1 holders
- Who pays nothing or less for prescriptions (aportación reducida)
- How the copayment works for your spouse and children
- Medicine costs on a short stay with an EHIC or GHIC
- When your prescription is not covered (medicamentos no financiados)
- Why the pharmacist gave you a different box (genéricos)
- Are medicines cheaper in Spain than at home?
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