Health authorities generally consider Lithuania to have a good standard of healthcare, particularly in the private sector. The public sector also offers some good quality health provision. The country’s healthcare system still faces some challenges, however, and one of these relates to the high level of out-of-pocket spending on pharmaceuticals. The Lithuanian government has been trying to address this in recent years.
What is available?
You may be asked for proof of health insurance on entering the country. We recommend that you also take a three-month supply of prescription medication into the country with you, in its original packaging. You may need to consult the local Lithuanian consulate, or the immigration authorities, regarding certain kinds of medication, such as painkillers that contain opiates.
If you are an EU citizen, remember to show your European Health Insurance Card (EHIC) and ID when you collect your prescription medication. If you are registered with the national health scheme, remember to take proof of this to your doctor and pharmacist. The Lithuanian health insurance fund (CHIF) will reimburse 50% to 100% of the costs of your medication, as long as it is approved by the Ministry of Health. You may need to pay the full price for some medication, if it does not feature on the approved list. If your medicine is on the approved list, the pharmacy will deduct the reimbursement from the initial cost.
Both GPs and pharmacists must inform patients about the prices and surcharges for any medicines that are listed under the same common name in the price-list of reimbursable medicines. You can find up-to-date information on the prices of reimbursable and non-reimbursable medicines by checking the website of the National Health Insurance Fund (NHIF) under the Ministry of Health (although this is in Lithuanian, so you may need a translator).
If you suffer from a chronic disease, you should initially be prescribed a course of treatment for a maximum of one month. If your medication proves to be effective, it can then be prescribed for up to three months. However, this rule does not apply for narcotic and psychotropic medicines, which must be prescribed for shorter periods.
If you do not have your passport for reimbursable medicines, these can still be prescribed on prescription form No. 3 for not longer than a seven-day period.
How much do prescriptions cost?
Paying for pharmaceuticals explains the high levels of out-of-pocket spending by patients in Lithuania, and there has been some recent contention in the local press regarding the cost of drugs.
The NHIF provides coverage for a number of benefits, and this may include reimbursement for medication. Out-of-pocket spending on medication forms the largest share of out-of-pocket payments overall. Patients may find themselves bearing the full costs of both prescribed and over-the-counter outpatient medicine, unless they belong to a group that is eligible for full or partial reimbursement. For instance, children, the elderly, and those who are registered as disabled, as well as patients with diseases such as tuberculosis, cancer and some chronic diseases, are eligible for reimbursement.
Even when the Compulsory Health Insurance Fund (CHIF) offers 100% reimbursement for medication, most patients will incur some form of copayment for outpatient pharmaceuticals, when the market price of the drugs is higher than the reimbursed reference price.
Lithuania has had one of the largest discrepancies between the amount of pharmaceutical costs funded publicly and the amount of overall health services. This is for several reasons:
Copayments for pharmaceuticals are high
- There is no effective Health Technology Assessment (HTA) in place
- Doctors tend to prescribe unnecessarily expensive brands
- There is a low reliance on generic medication
However, a new drug price list was introduced in July 2017, and this should have reduced the cost of user fees by up to a third. Up until this point, many Lithuanian patients bought their drugs over the border in Poland, due to the significantly lower prices there (€1 to €2 for a packet of cold medication, as opposed to €4 to €7).
Nonetheless, in 2018, the WHO reported that out-of-pocket spending on medicines was still a significant cause of financial hardship among Lithuanians. It recommended that policy attention should focus on improving the accessibility and affordability of outpatient prescribed medicines. Reforms introduced to lower medicine prices and encourage appropriate prescribing and dispensing are essential steps in the right direction. However, the WHO believes that further action is needed. Additionally, it asserts that Lithuania’s high use of non-prescribed medicines, especially among people aged over 65, also warrants policy attention.
How to get the care you need
You will be covered by state medical insurance if you are permanently resident in Lithuania. If you are not entitled to public health insurance, you will either need to take out private cover or pay out of pocket costs.
You will need to register with a local doctor. If you are under the CHIF and planning to use public healthcare, check that your local practice is registered with the national health service. Then, find your nearest pharmacy. There are a number of these throughout the country, particularly in the cities. In the 1990s, there were concerns about patients in rural areas being unable to access medication. The health authorities have attempted to address this, by registering primary care providers with pharmacy provision outside the main urban centres.
Lithuania’s Ministry of Health has recently proposed the implementation of a state-run ‘e-sveikata’ (‘e-health’) platform. This is an online gateway to patients’ medical history information, where patients can check the prices of any drugs in different pharmacies. They can order their prescription medication online, plus any medication that is reimbursed by the CHIF.
This plan has been opposed by the Lithuanian Association of Pharmacies, who says that the major chains already run online shops. So far, however, these pharmacy chains only sell non-prescription drugs, due to government regulation. If you think you might find this service helpful, check for updates on its implementation online.