CNAS reimbursed medicines: how 50%, 90%, 100% works (sublists B/C1/C2)

In Romania, the state (through CNAS - Casa Națională de Asigurări de Sănătate, the National Health Insurance House) reimburses 50%, 90% or 100% of a medicine's CANAMED (the national catalogue of maximum approved drug prices) reference price - provided that medicine is on one of the official sublists (A, B, C1, C2, C3, D) and that the prescription is issued for an eligible diagnosis. Here is exactly how the system and the sublists work, and what to ask your doctor for.

Legal framework - the OMS-CNAS framework contract

The basic medical services package - which also includes the reimbursed-medicines part - is set every year by a Government Decision (HG 696/2021, republished with 2022-2026 updates) and by the framework contract between the Ministry of Health and CNAS, approved by a joint MS-CNAS order. The framework contract details the sublists and the reimbursement percentages, valid throughout the whole year (sometimes with quarterly addenda).

The updated list and the sublists can be downloaded from cnas.ro → the „Furnizori” (Providers) section → „Medicamente” (Medicines) → „Liste medicamente compensate” (Reimbursed-medicines lists). Each medicine appears with its DCI (Denumire Comună Internațională - the international nonproprietary name), sublist, reimbursement percentage and CANAMED reference price.

Sublists A, B, C1, C2, C3, D - what they are

Sublist A - 90% reimbursement

The most common medicines for frequent chronic conditions: hypertension, hyperlipidaemia, type 2 diabetes mellitus, COPD, gout, hypothyroidism, chronic anaemia. The state pays 90%, the patient 10% of the reference price. Examples: enalapril, atorvastatin, metformin, levothyroxine.

Sublist B - 50% reimbursement (or 90% for pensioners)

Medicines for less frequent conditions or those with alternatives: certain anti-inflammatories, chronic allergies, anti-ulcer drugs. Pensioners with an income below the gross minimum wage receive 90% reimbursement on sublist B (instead of 50%).

Sublist C1 - 100% reimbursement by diagnosis

Treatments for serious chronic diseases: cancer, type 1 diabetes mellitus, multiple sclerosis, chronic viral hepatitis C, HIV/AIDS, cystic fibrosis, haemophilia, transplant. The reimbursement is 100% - the patient pays nothing - but it is tied to a specific ICD-10 diagnosis certified by the specialist physician.

Sublist C2 - national health programmes

National programmes (oncology, diabetes, haemophilia, rare diseases etc.) - access is granted through accredited centres, based on a commission assessment. The medicines are purchased centrally by CNAS and distributed free of charge to the beneficiary. Examples: imatinib (Glivec), analogue insulins, factor VIII for haemophilia A.

Sublist C3 - children, pregnant women, new mothers

100% reimbursement for: children aged 0-18, pregnant women, new mothers up to 6 months postpartum. The list comprises common medicines (paracetamol, antibiotics, antiallergics) and specific paediatric products.

Sublist D - patients with chronic mental illnesses

Antipsychotics, antidepressants, antiepileptics, anxiolytics - 90% or 100% reimbursement depending on the diagnosis. Requires a prescription from a psychiatrist or neurologist.

How the reimbursement is actually calculated

A concrete example - a chronic medicine, sublist A (90%):

• The pharmacy's shelf price: 45 RON.
• The CANAMED reference price for that DCI + strength: 40 RON.
• CNAS reimbursement (90% of 40 RON): 36 RON.
• You pay: 45 - 36 = 9 RON (or 4 RON, if the pharmacy's price is equal to the reference).

Here is the key point: the reimbursement is calculated from the CANAMED reference price, not from the pharmacy's price. If the pharmacy sells at a price higher than the reference, you pay the difference in full, on top of the 10% of the reference.

How to get a reimbursed prescription

1. You book an appointment with your family doctor (CNAS-insured, active contract).
2. You present your health card - the doctor sees your status in SIUI (Sistemul Informatic Unic Integrat - the unified integrated IT system of the health insurance).
3. After the consultation, if you have a diagnosis eligible for a sublist, the doctor issues the SIPE (the national electronic prescription system) prescription with the corresponding ICD-10 code and the sublist.
4. For chronic treatments, the family doctor can issue them directly (atorvastatin, enalapril etc.). For oncology, haemophilia, multiple sclerosis etc. - a specialist physician or accredited centre is required.
5. With the SIPE prescription and your card, you go to any pharmacy with a CNAS contract (all the major chains + most independents).

Common pitfalls - what to watch out for

• Missing diagnosis: without an ICD-10 on the prescription, the pharmacy cannot apply the reimbursement. Back to the doctor.
• Expired or blocked card: you check your status on cnas.ro. If you have stopped your contributions (CASS - the health insurance contribution), the insurance is not active - you do not get the reimbursement. You must pay contributions for at least 6 months back to become insured again.
• Generic substitution: the pharmacist can give you a different manufacturer for the same DCI and the reference price is the same. If you insist on the more expensive brand, you pay the difference in full.
• Prescriptions for chronic patients - 30/60/90 days: make sure the doctor ticks the correct duration. If they take only 30 days when you could have 90, you make extra trips.

The health card - how it works in detail

The health card issued by CNAS is the physical instrument that confirms your insured status and activates the automatic reimbursement. It has a chip with an individual digital certificate which, when inserted into the reader, opens a secure session to the CNAS database and reads the identification data. A few useful technical points:

• The PIN - received at activation. Initially 0000 or set on receipt. It is recommended that you change it on first use (at the doctor's office or at the pharmacy). 3 incorrect entries block the card; unblocking is done at the County House (Casa Județeană - the county health-insurance office).
• Validity - cards issued after 2014 have technically unlimited validity. The chip lasts 10-15 years. Cases of malfunction (physical wear, demagnetisation) lead to free re-issue.
• Loss / theft - a declaration at the County House, immediate blocking in the CNAS database, re-issue within 5-10 working days. In the meantime, you use the printed insured certificate.
• Transfer between counties - the card remains valid nationally. A change of address is notified separately to CNAS for updating in the insured-persons database.

The insured certificate is the alternative to the card. You print it from cnas.ro after logging in with your CNP (Cod Numeric Personal - the personal numeric code) + password or a digital certificate. It contains the name, CNP, the current status of the insurance (active/inactive) and the date of the last contribution. It is valid at the pharmacy as the equivalent of the physical card.

Specific rules for issuing reimbursed prescriptions

The MS-CNAS framework contract regulates not only what is reimbursed, but also how the prescription is issued. A few important rules worth knowing, validated by the joint MS-CNAS Order 1068/627/2021 (with subsequent updates):

• A maximum of 7 medicines on a single prescription - if you have more, the doctor issues two separate prescriptions. The limit is technical (the SIPE form allows 7 lines) but also clinical (the rationalisation of polypharmacy).
• Quantity proportional to the duration - for 90-day chronic prescriptions, the dose × days is calculated, with no surplus. SIPE automatically blocks any overruns.
• DCI prescribing is mandatory - the doctor writes the DCI (atorvastatin), not the brand name (Lipitor), to allow substitution. Exception: documented medical cases (intolerance to excipients, demonstrated difference in efficacy).
• An ICD-10 diagnosis is mandatory - without it, the reimbursement does not apply. The code corresponds to the sublist: you cannot get sublist A for a diagnosis that is not listed there.
• Periodic re-evaluation - at each issue of a chronic prescription, the family doctor performs a short check (blood pressure, blood glucose, possibly an ECG, blood tests once a year).

The personal contribution - a real-world case

To understand how much you actually pay, take an example on sublist A (90% reimbursement):

• Medicine: amlodipine 10 mg, 30 tablets, Krka generic.
• Maximum CANAMED retail price (PVA - preț cu amănuntul, the retail price): 14.80 RON.
• Reference price: 11.20 RON (the cheapest listed generic).
• CNAS reimbursement: 90% × 11.20 = 10.08 RON.
• Pharmacy A sells at 11.20 RON (equal to the reference) → you pay 11.20 - 10.08 = 1.12 RON.
• Pharmacy B sells at 14.80 RON (maximum PVA) → you pay 14.80 - 10.08 = 4.72 RON.

The difference between the two pharmacies for the same medicine with the same reimbursement is 3.60 RON per month. Per year, ~43 RON. Across 4 medicines, ~170 RON saved. That is why the price comparator makes sense even for reimbursed medicines.

National programmes - completely free

For the diseases in sublist C2, the system works through National Health Programmes (PNS - Programe Naționale de Sănătate) coordinated by CNAS and the Ministry of Health. You pay nothing - and you do not buy from a private pharmacy, but directly from the accredited centre (oncology clinic, haemophilia centre, MS centre etc.). The list of PNS and accredited centres is on cnas.ro/programe-nationale-de-sanatate.