Substitution (replacement) means that the pharmacy dispenses another and cheaper medicine than the one your doctor prescribed.
- contain the same active substance,
- in the same quantity, and
- are used in the same way (for example tablets and capsules for oral intake).
The medicines have the same effect, even though they look different and are sold under different names. They are called generic medicines or only generics.
At medicinpriser.dk you can see which medicines can be replaced by the medicine that your doctor wrote on the prescription. All the medicines have been scientifically evaluated by the Danish Medicines Agency.
The pharmacy must nearly always dispense the cheapest medicine.
But there are a few exceptions:
- If your doctor has written "ej S" ("no S" - do not substitute), the pharmacy must dispense the medicine specifically written on the prescription. In this case, the patient must pay the price difference between the cheapest medicine and the one prescribed.
- The patient is free to choose any of the products in a group of generic medicines. But, the patient must pay the price difference between the cheapest medicine and the one dispensed.
- If the price difference between the cheapest medicine and the one specifically prescribed is only marginal - DKK 5 to 20 depending on the price of the medicine - the pharmacy can choose to dispense the medicine specifically prescribed. The patient must pay the price difference between the cheapest medicine and the one dispensed.
- Pharmacies have no obligation to make generic substitution when they sell medicines over the counter - without a prescription.
But the customer has every right to ask the pharmacy to dispense the cheapest medicine, unless the doctor has written "ej S" ("no S" - do not substitute) on the prescription.
The pharmacies nearly always have the cheapest medicine in stock, but if not, they can have it in stock within a short period of time. In Denmark, there must always be at least one medicine eligible for full reimbursement on the market.
Why do prices differ that much?
When a company develops a new medicine, its invention is patented. This patent expires after a number of years, and other pharmaceutical companies are then free to copy the original version.
The price of copy medicine (generic medicine) or parallel imported medicine is often lower than the price of the original product. This is because it is far cheaper to copy a medicine than it is to develop it.
Therefore, the price difference does not reflect a variation in neither effect nor quality.
The reimbursement price of reimbursable medicines equals the price of the cheapest medicine in the group of interchangeable medicines. If the patient or doctor has chosen a medicine that is more expensive than the reimbursement price, the patient must pay the price difference himself.