Why the pharmacist gave you a different box (genéricos)

Terms used

• Principio activo — The principio activo is the active ingredient of a medicine, the substance that does the work, such as paracetamol.
• EFG — An EFG is a generic medicine, named by its active ingredient plus the manufacturer.
• Conjunto homogéneo — A conjunto homogéneo is a group of medicines with the same ingredient, dose, form and route, including at least one generic.
• Precio de referencia — The precio de referencia is the highest price the public system pays for medicines in a homogeneous group.
• CIMA — CIMA is the online database of authorised medicines run by Spain's medicines agency.

Key rules

• Price difference: If a medicine costs more than its reference price, you pay the difference on top of your usual copayment.
• Cheapest option: The cheapest option, or any medicine at or below the reference price, carries no extra charge.
• No-swap medicines: Biological medicines and narrow-range medicines cannot be swapped unless the prescriber authorises it.
• Matching: Match a foreign medicine by its active ingredient, strength and form, not its brand name.

The short answer

A different box is usually the same medicine. The pharmacist can swap a brand for another product with the same active ingredient, dose, form and route, as long as it costs no more than the one prescribed. If a medicine costs more than its reference price, you pay the difference.

How generics and active ingredients work

Spanish boxes show a brand name and the active ingredient (principio activo). The ingredient is written in Spanish form, such as paracetamol or ibuprofeno. Generics (EFG) are named by the active ingredient plus the manufacturer. Doctors in the public system prescribe by active ingredient, so your prescription may not name a brand at all.

If the prescription names only the ingredient (denominación oficial), the pharmacist gives you the cheapest available medicine with that ingredient. That is why your box can change from one month to the next.

If the prescription names a brand, the pharmacist can swap it only if the medicine is not on the non-substitutable list. The same applies to public and private prescriptions. If your prescribed brand is out of stock, the pharmacist may give you a cheaper equivalent and must record it.

Who pays the price difference

Medicines with the same ingredient, dose, form and route, and at least one generic on the market, are grouped in a conjunto homogéneo. Each group has a precio de referencia, which is set by the Ministry of Health and based on the lowest-cost medicines. The public system pays only up to that price.

The percentage is charged on the pharmacy price, and if a medicine costs more than its reference price you also pay the difference. In practice:

• If you get the cheapest option, or any medicine priced at or below the reference price, there is no extra charge.
• If you insist on a pricier brand in the group, you pay your normal copayment on the funded part plus the whole excess.

The Ministry revises reference prices at least once a year, so a box that cost nothing extra last year may carry a difference now. Ask the pharmacist before you accept a pricier brand.

What cannot be swapped

The pharmacist cannot substitute these unless the prescriber authorises it:

• medicines with a narrow therapeutic range, such as some antiepileptics and anticoagulants
• biological medicines
• medicines for special control or hospital use
• medicines where the prescription says no substitution is allowed

The Ministry's categories also include medicines needing precise dosing and inhalers. The detailed list can change, so check the current Ministry list or ask the pharmacist. If you rely on one of these products, ask your doctor to mark the prescription "no substitution".

Matching a medicine from home

Brand names differ from country to country, and strengths and pack sizes may too. The reliable key is the active ingredient. Read the ingredient, strength and form on your foreign box. Then search for the ingredient in CIMA, the Spanish medicines agency's online database. Or show the box to the pharmacist, who can match it.

The questions below cover the most common doubts.

Frequently asked questions

Which medicines can the pharmacist not swap for another box?

The pharmacist cannot swap medicines with a narrow therapeutic range, such as some antiepileptics and anticoagulants, or biological medicines, unless the prescriber allows it. The same goes for inhalers, medicines for hospital or special-control use, and any prescription that says no substitution. Ask your doctor to mark the prescription if you must keep your usual product.

What does the pharmacist have to match when giving a different box?

The substitute must have the same active ingredient, dose, form and route, and must cost no more than the one prescribed. If your prescribed brand is out of stock, the pharmacist may give a cheaper equivalent and must record it. If the prescription names only an active ingredient, you get the cheapest available option.

How can I match a medicine from my home country to a Spanish one?

Find the active ingredient, strength and form on your foreign box, then search that ingredient in CIMA, the Spanish medicines database. The pharmacist can also match it for you. Brand names and pack sizes often differ between countries, so the active ingredient is the reliable key.

How often do reference prices change?

The Ministry of Health revises the reference price system at least once a year, usually announced by order. A medicine that cost nothing extra last year could therefore land above the reference price later. Ask the pharmacist for an option at or below the reference price to avoid paying the difference.