The new framework agreement regarding the conditions for providing medical assistance
The new Framework Agreement regarding the conditions for
providing medical assistance within the system of social health
insurances for the year 2008 entered into force on 01.04.2008.
Primary Medical Assistance
The new Framework Agreement comprises
a series of amendments which
aim, among other things, at facilitating
the access to primary medical assistance.
Thus, the minimum number of insured persons on the list of a family doctor is
no more 2000. In the urban localities, the family doctors (both the ones who had previous agreements and the newly registered ones) are obliged to have registered on their lists a minimum number of 1000 insured persons until 31.12.2008.
The doctors’ offices will run with minimum one medical assistant, irrespective
of the number of insured persons registered on the list.
The family doctors will refuse the transcription of medical prescriptions for
medicines with or without the personal contribution of the insured persons and paraclinical investigations which are a consequence of the medical acts of other doctors. The Framework Agreement stipulates the exceptions to the above mentioned disposition; such an exception is represented by the prescription of medicines with and without personal contribution upon the recommendation of the labour medicine doctor, whereas this recommendation has to be transmitted by medical letter.
The guaranteed minimum values of the “per capita” point and of the point for
the payment for the service have been increased to RON 4.61, and respectively to RON 1.91 according to the Methodological Norms for the implementation of the Framework Agreement.
Among the punishable deeds of the family doctors there are the unjustified
non-observance of the working hours, as well as medically unjustifi ed prescriptions of medicines with and without the personal contribution of the insured person and/or recommendations of paraclinical investigations, as well as the transcription of medical prescriptions for medicines with or without the personal contribution of the insured person and paraclinical investigations which are a consequence of the medical actions of other doctors. The sanction consists in the progressive percentage reduction up to 20% of the guaranteed minimum value of the per capita point for the month in which these situations have occurred.
Rights and Obligations of the Suppliers of Medicines
One of the obligations of the suppliers of
medicines is represented by the supply, at
the request of the insured person, within
maximum 12 hours for acute and subacute
illnesses and 48 hours for chronic
illnesses, with the medicines from the
List of the trade names of the medicines, in case these do not exist in the pharmacy at the moment of request.
The supplier of medicines will not replace the medicines prescribed by the
doctor, except for the following situations:
(i) if the medicine recommended by the doctor is too expensive and the ill person does not have the necessary fi nancial sources to pay the difference
between the reference price and the retail sale price of that medicine;
(ii) if the pharmacy has no available stock, at the moment of request, of the product prescribed by the doctor and the ill person does not agree that the pharmacy will supply him with this medicine within the above - mentioned deadlines.
The Framework Agreement stipulates that the doctors will prescribe the
medicines under their trade name. This provision puts thus an end to the long
discussions regarding the manner how the prescription of the medicines should take place, namely in the form of the trade name of the product or as active substance.
The health insurance houses have the obligation to notify the suppliers of
medicines with regard to the name and the paraph code of the doctors who no longer have contractual relationships with the health insurance house, the latest on the date when the contractual relations between the health insurance house and those doctors cease.
As the termination of the contract for the supply of medicines is concerned, the
Framework Agreement provides for cases when the conditions for the termination of the agreements apply at company level, as well as cases when the termination conditions apply correspondingly for each of the pharmacies/operating sites where these situations occur, by excluding them from the agreement and amending the agreement correspondingly.
In case that the pharmacies/operating sites excluded from the agreements
concluded between the pharmaceutical companies and the health insurance
house continue to sell medicines with or without personal contribution within the system of social health insurances, the health insurance house will terminate the agreements concluded with those companies for all the pharmacies/operating sites included in these agreements.
Irina Stanica, Attorney-at-Law
28th C General Constantin
Budisteanu, 1st District, RO-010775
Tel.: +40-(0)21-312 58 88
Fax: +40-(0)21-312 58 89