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.
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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
Bucuresti
Tel.: +40-(0)21-312 58 88
Fax: +40-(0)21-312 58 89
irina.stanica@noerr.com
www.noerr.com
