Refundability of drugs



The reimbursement of a drug or a medicine means the possibility of obtaining the drug for free, at the expense of the National Health Service (SSN), subject to payment of a small fee called a "ticket".

In Italy, based on reimbursement by the NHS, drugs are classified into three main categories:

  • Class A medicines, reimbursable by the SSN
  • Class C medicines, paid by the citizen
  • Band H medicines, usable only in hospitals and reimbursed by the NHS

A band B was also envisaged until 1 July 2001, which included non-essential medicines but of important therapeutic interest, only partly paid for by the NHS.

The wording band can be replaced by the term class.

Class A and H medicines

Class A medicines are drugs considered essential to ensure the treatments provided for in the Essential Levels of Assistance (LEA), i.e. the services and services that the National Health Service (SSN) is required to provide to all citizens with the public resources collected. through taxes.

Class A medicines are therefore paid for by the NHS and are used for severe (acute), sudden onset or persistent (chronic) diseases, including rare diseases. They must be prescribed by the family doctor or by the doctors on call, hospital or emergency room, and must bear the inscription "to be sold on presentation of a prescription"On the outer packaging.

Some of them (band H), due to their pharmacological characteristics, because they are new or for safety reasons, can only be dispensed in hospitals or in structures similar to the latter. Furthermore, for some drugs the reimbursement is foreseen only for some therapeutic indications (or diseases) and in this case they must be prescribed on a particular type of prescription in the presence of a "therapeutic plan", following the assessment of the disease by centers specialist recognized by the Regions.

Medicines included in range A and H, with their reference prices are listed in a transparency list, prepared by the Italian Medicines Agency (AIFA), which is periodically updated and is valid throughout the national territory. The reference price indicated on the transparency list represents the maximum value reimbursable by the NHS for a medicine containing a certain active ingredient (component responsible for the curative activity), at a certain dosage and in a certain pharmaceutical form (for example, tablets, ampoules, syrup, etc.). If the citizen decides to buy a class A drug, with the active ingredient equivalent to that included in the transparency list, but with a higher price than the reference price indicated in the list itself, you will have to pay the difference at the pharmacy.

The regional ticket

Theoretically, in any region a patient should be able to go to the pharmacy and receive the same medicine free of charge. In reality, most of the Regions ask for a participation fee or "ticket" to be paid by the citizen himself. It is usually a fixed amount on the individual medicine pack or prescription. The ticket is not provided, however, for medicines administered on an inpatient or outpatient basis (band H) which are completely free.

The drug ticket is established at the regional level and this creates a great disparity between the individual regions. In fact, they range from no ticket in Piedmont, Friuli Venezia Giulia, Marche and Sardinia, to 1 euro per recipe in Trento, 2 euro per package (maximum 4 euro per recipe) in Liguria, 4 euro per package (8 euro per recipe) ) in Tuscany, or different tickets based on the price of the drug in other Regions.

The individual Regions have also independently identified the categories of people who are exempt from the ticket (do not pay) because they are affected by chronic diseases or by age or income. It is therefore advisable to contact the Local Health Authority (ASL) or the Region to which you belong directly to find out if you are entitled to the exemption.

Class C medicines

Class C medicines are drugs used for minor illnesses, not considered "essential" or "life-saving" and, therefore, not covered by the National Health Service (SSN).

The only exception is represented by persons entitled to a life-long direct war pension (Article 1, Law no. 203 of 19 July 2000) who can receive drugs free of charge from the NHS if the general practitioner certifies their therapeutic usefulness. .

Therefore, Class C medicines are the sole responsibility of the citizen and can be dispensed following presentation of a medical prescription (range C with prescription), or be purchased directly without a prescription (range C-bis), when it is not medical supervision required for their use.

To this last category belong:

  • over-the-counter medicines (from the "English" over the counter ", OTC), prepackaged and" self-medicating "(used for minor ailments) that can be displayed in the pharmacy and advertised
  • non-prescription medicines (SOP), but not over the counter, can only be dispensed by the pharmacist and cannot be advertised

Medicines in band C-bis, OTC and SOP, must be respectively marked with the stamps self-medication medicine And medicine not subject to medical prescription clearly visible on the package.

Online sales are permitted exclusively for OTC and SOP. The latter, however, is prohibited for all other medicines for which a medical prescription is required.

Pricing of Medicines

The "Italian Medicines Agency (AIFA) with its technical-advisory commissions" establishes the conditions of supply and reimbursement of all medicines authorized for marketing in Italy. A and H, which are borne by the National Health Service (SSN), through negotiation with the pharmaceutical companies that hold the authorization for placing them on the market. The so-called transparency list which shows the list of all drugs included in range A and H with the relative reference prices.

For class C medicines, on the other hand, the retail price is established by each owner of a pharmacy, parapharmacy or other commercial establishment and must be clearly visible to the public at the point of sale, through price lists. Law Decree 1/2012 also established that pharmacies can offer discounts on the prices of all types of drugs and products paid for directly by customers. AIFA carries out a monitoring action on the price of class C drugs with medical prescription.

In-depth link

Ministry of Health. Refundability

Italian Medicines Agency (AIFA). Negotiation and reimbursement

Editor'S Choice 2022

Chili pepper

Chili pepper

Chilli is a plant belonging to the Solanaceae family grown all over the world and commonly used as a spice in kitchens all over the world. It is rich in minerals, vitamins and some polyphenols which can have beneficial effects

Bathing waters

Bathing waters

The "bathing waters", that is to say waters in which it is possible to 'bathe' and carry out recreational or sports activities, must be 'clean', i.e. free from both microbiological (due to the presence of microorganisms such as bacteria, viruses) and chemical contamination



Tachycardia consists of an increase in the number of heart beats which occurs even in conditions of rest and in the absence of physical activity, stress