Information package: Medicines
Kela has several responsibilities in the area of medicines. The following is an overview of the Finnish prescription drug reimbursement system, medicine consumption and costs, and the statistics and research produced by Kela on topics related to medicines.
Majority of Finns buy medicines reimbursed under the National Health Insurance scheme
Medicines are the principal treatment option for many illnesses. In Finland, electronic prescriptions are used to prescribe outpatient medicines, which are dispensed by pharmacies.
Reimbursements for the dispensed medicines are usually provided as a direct reimbursement at the pharmacy. This means that the client only pays a copayment, and Kela compensates the pharmacy later for the reimbursed portion of the costs. Each resident of Finland is entitled to reimbursements for medicine costs regardless of their place of residence or other factors.
In 2023, 3.9 million Finns purchased medicines reimbursable under the National Health Insurance (NHI). Reimbursements for medicine costs were paid to around 3 million persons at a total cost of EUR 1.8 billion. The total expenditure on medicines reimbursable under NHI came to EUR 2.5 billion.
The statistics are based on the date of purchase and also include additional reimbursements paid after the fact. They do not include purchases reimbursed after the fact on the basis of a separate claim.
Reimbursements for medicine costs are a major category of benefit expenditure for Kela: in 2022, they accounted for 35% of all reimbursements Kela paid under NHI.
Severity of illness is related to the rate of reimbursement for medicines
The Finnish reimbursement system for prescription medicines is based on the idea that everyone is treated equally when it comes to the payment of reimbursements. The severity of an illness is related to the rate of reimbursement.
There are three reimbursement categories:
- basic rate of reimbursement: Kela pays 40% of the price of the medicine
- lower special rate of reimbursement: Kela pays 65% of the price of the medicine
- higher special rate of reimbursement: Kela pays 100% of the price of the medicine minus a EUR 4.50 copayment.
All reimbursable medicines qualify for at least the basic rate of reimbursement. The lower special rate covers medicines used in the treatment of many severe, chronic illnesses, including cardiovascular diseases.
The higher special rate includes medicines essential to the treatment of a chronic illness, such as insulins used in the treatment of diabetes and many cancer medications.
The annual maximum limit on out-of-pocket medicine expenses is designed to ensure that patients do not have to spend an excessive amount on their medicines. Patients whose reimbursable medicine purchases exceed the maximum limit (EUR 626.94 as of 2024) only pay a EUR 2.50 copayment for each subsequent purchase of reimbursable medicines. There is also a EUR 50 initial deductible (reimbursement threshold) on medicines.
However, not all medicines are reimbursable. The Pharmaceuticals Pricing Board issues decisions on reimbursement status based on applications from pharmaceutical companies.
Most recipients of reimbursements for medicine costs are of working age, but the elderly receive the largest portion of the reimbursement expenditure
There are differences between age groups in terms of the amount and type of medicines used. Working-aged people are the largest category of recipients of reimbursements for medicine costs. However, the elderly make up an increasing share of the recipients as the Finnish population continues to grow older.
In 2023, as many as 1.3 million persons aged 65 or over purchased medicines for which they received National Health Insurance reimbursements.
The elderly receive the largest portion of the reimbursements. One explanation for this is the fact that many of them use several different medications.
Expenditure by Kela on reimbursements for medicine expenses in 2023:
- EUR 872 million to persons aged 65 or over
- EUR 833 million to persons aged 18–64
- EUR 75 million to persons under age 18
Medicine expenditure has increased steadily since the beginning of the 2000s
The expenditure on medicines reimbursed under the National Health Insurance, along with the reimbursements themselves, have increased over the past 20 years. Medicine expenditure (including the National Health Insurance and the patients’ out-of-pocket spending) increased from EUR 1.2 billion in 2001 to EUR 2.5 billion in 2023, roughly doubling over 20 years.
The biggest reasons are the ageing of the Finnish population and the increased use of medicines. Also, new medicines are typically expensive. They have enabled the pharmaceutical treatment of illnesses that only a few years earlier were untreatable. Given the push to introduce them to clinical use as quickly as possible, scientific evidence of their efficacy can often be lacking.
The introduction of generic substitution and a reference price system, along with cuts in medicines’ wholesale prices, have been some of the methods used in the 21st century to curb the increase in medicine expenditure. The government's share of the expenditure has also been reduced. In fact, the last few years have seen a moderation in the rate of increase of medicine expenditure.
Analgesics and cardiovascular medicines are the most common categories of medicine used by Finns
In terms of the number of recipients of reimbursements for medicine expenses, the largest category of medicine were those that affect the central nervous system. They were bought by nearly 1.9 million individuals in 2023. This category includes many widely used analgesics, reimbursements for which were paid to more than 1.2 million persons, antidepressants, reimbursed to 600,000 persons, and sleep medicines.
There were also more than 1.8 million users of cardiovascular medicines. This group includes medicines used in the treatment of coronary disease, arrhythmia and hypertension, as well as anticholesterol drugs.
The regional prevalence of medicine use in the treatment of a number of common illnesses can be studied for example with this application.
Despite a relatively small number of users, cancer medications and immunomodulators account for the highest share of total medicine expenditures
The cost of medication was highest in the group consisting of cancer medicines and immunomodulating agents. Total expenditure on these drugs reached EUR 639 million in 2023. Medicines in this group were purchased by some 175,000 individuals. The group includes high-cost cancer drugs and biologic medicines used in the treatment of autoimmune disorders, including rheumatoid arthritis.
The second largest category in terms of expenditure was the group of medicines for gastrointestinal diseases and metabolic disorders. Medicines in this group, which includes diabetes drugs, were purchased by more than 1.2 million individuals.
Kela Research as a producer of pharmaceutical data
The research that Kela’s research unit does on medicines and the pharmaceutical sector focuses on the structures and systems inherent in the pharmaceutical sector; the prescribing, consumption, costs, reimbursements and availability of medicines; and the promotion of rational drug therapy.
Kela research staff are also involved as experts in development projects within the pharmaceutical sector and help to prepare statements on drug pricing and reimbursability.
Information about medicines and the research on medicines
The use and cost of medicines: statistical data and applications
Kelasto statistical database
The Kelasto statistical database contains key statistical data on the social security schemes administered by Kela. With Kelasto you can create custom reports from the statistical data compiled by Kela. Click the links in the Medicines subject area to access statistical data on medicines.
Finnish Statistics on Medicines
The Finnish Statistics on Medicines is a statistical publication from Kela and Fimea, the Finnish Medicines Agency, containing data on the consumption of prescription drugs and on National Health Insurance reimbursements.
Finnish Statistics on Medicines
Purchases of prescription medicines by ATC class
This application can be used to track and compare the consumption and costs of outpatient prescription medicines in all of Finland and in wellbeing services counties. Updated weekly, it can highlight even quite rapid changes. It allows users to compare the overall consumption of medicines with the levels seen in previous years or to study trends in specific medicine categories or products.
Purchases of prescription medicines by ATC class
Cost comparisons between medicines used in outpatient and inpatient settings
Created by Kela Research and Fimea, this application can identify medicinal products whose costs have increased or decreased the most across the whole country or in specific hospital districts or wellbeing services counties. The medicinal products can be analysed by ATC class. Users can analyse the data according to outpatient or inpatient use, the increase or decrease of costs, specific regions, or different start and end dates.
Cost comparisons between medicines used in outpatient and inpatient settings
Medicines used in the treatment of certain common illnesses: Special reimbursement and costs
This application can be used to look at the prevalence of certain illnesses that are particularly common in the Finnish population by focusing on the consumption of medicines and awarded entitlements to special reimbursement. The data can be analysed according to three-year index periods, by gender, in age-standardised or non-standardised form, or in specific wellbeing services counties and local government joint services areas.
Medicines used in the treatment of certain common illnesses: Special reimbursement and costs
