The health plans are not obligated to provide specific drugs produced by specific manufacturers. They are only required to provide drugs with the identical active ingredient
Policyholders may claim that the health plan is obligated to continue providing the same name-brand drug due to medical considerations and the principle of treatment continuity
If a doctor's prescription does not explicitly call for a name-brand drug, a pharmacist may provide a generic equivalent, even if the brand-name drug's name was used on the prescription
- Brand-name drugs are those which were originally developed by the manufacturer and are patent-protected.
- After patent protection expires, other companies may manufacture copy versions of the drug.
- These copies are called generic drugs and they have the same active ingredient and are less expensive than the original.
- If a drug is included in the healthcare basket, the health plans are not obligated to provide that specific drug produced by a specific manufacturer; they are only required to provide a drug with an identical active ingredient.
- According to Section 27 of the Pharmacists Ordinance (New Version), 5741-1981, if a doctor did not explicitly order the brand-name drug for a patient on a prescription, a pharmacist may provide the patient with a generic drug, even if brand-name was used on the prescription.
- On some health plan prescription forms, it is indicated that pharmacists are permitted to supply a generic equivalent in place of a brand-name drug.
- Even if drugs are identical, patients sometimes complain about differences between a brand-name drug and a generic equivalent. In such cases, if a patient took a specific brand-name drug and the health plan replaced it with a generic equivalent, the policyholder may claim that the health plan is obligated to continue providing the original brand-name drug due to medical considerations and the Principle of Treatment Continuity.
Who is Eligible?
- All health insurance policyholders.
How to Claim It?
- Policyholders wishing to obtain a specific brand-name drug may do the following:
- Ask the attending physician to explicitly indicate on the prescription that a brand-name drug is to be supplied and not a generic equivalent.
- Policyholders requesting to obligate the health plan to continue providing a specific brand-name drug must support their claim that there are differences between the drugs with medical documentation, and they must contact their health Fund's ombudsman or the Ministry of Health's National Health Insurance Law Ombudsman.
- There are differences between the health plans regarding which drugs are provided. Accordingly, policyholders interested in a specific brand-name drug may check which health plans provide it. Policyholders may switch health plans if the drug is available through another plan.
- For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.
- The Ministry of Health
- The Ministry of Health's Pharmacological Products Department
- National Health Insurance Law Ombudsman
Laws and Regulations
- The National Health Insurance Law
- National Health Insurance Order (Medications in the Healthcare Services Basket)
- Pharmacists Ordinance (New Version), 5741-1981 - Section 27 (courtesy of Nevo)
- Original information written by the Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel.
- English translation and maintenance by The Shira Pransky Project.