What you do not pay: hospital medication
Everything given or dispensed at the hospital is free: intravenous chemotherapy (FOLFOX, FOLFIRI…), antibodies (bevacizumab, cetuximab, panitumumab), immunotherapy, oral drugs dispensed by the hospital pharmacy (encorafenib, regorafenib, trifluridine/tipiracil, sotorasib…) and medication during admissions. There is no copayment and no bill. The same applies to tests (CT, PET, biopsies, molecular tests) and radiotherapy.
What does carry a charge: community pharmacy prescriptions
Medicines you collect at a high-street pharmacy on prescription (anti-sickness drugs, painkillers, stomach protectors, loperamide, creams, heparin, sometimes capecitabine depending on the region) follow the general pharmaceutical copayment:
| Situation | What you pay |
|---|---|
| Working-age insured (and dependants), by income band | A percentage of the price (40 %, 50 % or 60 % by income), with no monthly cap |
| Pensioners, by income band | A lower percentage (10 % for most) with a monthly cap per income band |
| Exempt | 0 %: recipients of social integration income, non-contributory pensions, unemployed without benefit, minimum living income, minors with ≥33 % disability, low-income pensioners, people treated for work accidents or occupational disease |
The exact bands and caps are set by law and can change; the current figures are on the Ministry of Health website. Your band is assigned by Social Security from your tax return and appears on your health card (TSI code).
Reduced contribution ("cícero")
Medicines for chronic or serious diseases, marked on the box with a black dot or "cícero", carry a small fixed contribution per pack with a cap, regardless of income band. Some oncology supportive-care drugs fall into this category. Ask at the pharmacy.
Stoma supplies and other products
Stoma bags, flanges, pastes and accessories are covered with a reduced contribution, and in many regions at no cost to the patient. They are dispensed by the pharmacy on prescription, with monthly unit limits that the doctor or stoma nurse can extend with justification. Oral nutritional supplements (shakes) are funded on prescription when indicated (malnutrition, difficulty eating): ask nutrition or oncology for the report.
If you think you are being overcharged
- Check your contribution band on your card or your health service app. If your income has fallen because of the illness (sick leave, unemployment), you can request a band review with evidence of the new situation; this is done at the INSS or your health service depending on the region.
- If you have become a pensioner through incapacity, make sure the system records you as such (the copayment falls and a monthly cap applies). Amounts paid above the cap are refunded automatically or on request depending on the region: ask.
- If a drug should be hospital-dispensed but is being sent to the high-street pharmacy, raise it with oncology.
- Keep receipts. Complaints go to Patient Services or the regional health department.
Unfunded medicines and "compassionate use"
If your oncologist wants to use a drug that is not yet funded in Spain for your indication, the hospital can request it through the special situations routes (compassionate use, off-label) via the AEMPS (Spanish medicines agency) and the hospital pharmacy: you do not pay in that case either. What the system does not cover is medication you buy yourself abroad or privately.
What to ask at your appointment
- Hospital pharmacy: which medicines do I collect here and which on prescription outside?
- Is my copayment band correct? My income has changed with sick leave.
- Stoma nurse: how many units a month am I covered for and how are they extended?
- Can I have nutritional supplements on prescription?
- Social worker: is there help with pharmacy costs if I cannot manage?