Will your private insurance pay for your medicines?

Key rules

• Outpatient medicines: Standard private policies do not refund medicines you buy at a pharmacy.
• Hospital stay: Medicines given while you are admitted are normally part of the hospital cover.
• Add-ons: Pharmacy riders exist with some insurers, usually with an annual cap and a copay.
• Discounts: A partner-pharmacy discount is not a reimbursement.

The short answer

Most Spanish private health policies do not reimburse medicines you buy at a pharmacy. You pay the full pharmacy price yourself. Your insurer covers consultations, tests and hospital care, but it normally excludes outpatient drugs.

What this means at the pharmacy

When a private doctor gives you a prescription, you pay for the medicine in full and the insurer does not refund it. If you are also entitled to public healthcare, you can get a public-system prescription instead. You then pay only the usual copay, which is the part of the price the patient pays.

Where your policy may pay

There are a few exceptions. Check each one in your policy.

• Hospital stays. Medicines given while you are admitted are included in the stay and in day-surgery cover.
• Hospital treatments. Drugs such as chemotherapy and other cancer treatments, given in hospital or a day hospital, are often covered.
• Treatments given in the clinic. Some policies include specific items, such as vaccines or contrast agents, and treatments administered at the clinic.
• Pharmacy add-ons. Some insurers sell optional riders that cover pharmacy costs. They usually have an annual cap and a copay.
• Reimbursement products. Some premium or reembolso policies work differently from standard ones. Read the terms before you assume anything.

Discounts are not reimbursement

Some insurers offer discounts at partner pharmacies. A discount lowers the price you pay. It does not refund you, so do not count it as cover.

What to do before you buy or rely on a policy

1. Open the policy's general conditions and find the exclusions section.
2. Look for the words "medicamentos" and "farmacia". Note any annual cap or copay.
3. Ask the insurer in writing whether a pharmacy rider is available and what it costs.
4. Budget for regular medicines as an out-of-pocket cost if you take them every month.

The decision and FAQ below help you choose how to pay for your medicines.

Choosing between options

How will you pay for your medicines?

• Pay the pharmacy yourself: Fits for medicines you buy at a pharmacy on an outpatient basis. Standard private policies do not reimburse these, so you pay the full price.

• Use a public-system prescription: Fits if you are also entitled to public care. You pay the usual copay at the pharmacy.

• Rely on your policy's hospital cover: Fits for medicines given during a hospital admission, day surgery, or treatments such as chemotherapy given in hospital or a day hospital.

• Add a pharmacy rider: Fits if you expect regular pharmacy costs. Some insurers offer one, usually with a yearly cap and a copay.

If a doctor gives you the medicine in hospital or in the clinic, your policy is likely to cover it. If you buy it at a pharmacy, expect to pay yourself unless you have a pharmacy add-on.

Frequently asked questions

Does my insurance pay for medicines given during a hospital stay?

Yes, medicines given while you are admitted to hospital are normally included in the cost of the stay and day-surgery cover.

Can I add pharmacy cover to my policy?

Yes, some insurers offer optional add-ons for pharmacy costs, but they usually come with a yearly cap and a copay. Ask your insurer for the add-on's limits before you sign up.

Do pharmacy discounts from my insurer count as reimbursement?

No, a discount at a partner pharmacy is not a reimbursement. You still pay at the pharmacy, just at a lower price.