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(Medications Included in the Healthcare Basket)
 
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{{עצם העניין}}{{סוג ערך|זכות}}
 
{{עצם העניין}}{{סוג ערך|זכות}}
{{תקציר}}
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{{תקציר |תוכן=
 
{{דגשים  
 
{{דגשים  
 
| מידע = The health plans are required by law to provide the medications included in [[The Healthcare Basket|the healthcare basket]] to policyholders, subject to relevant [[:he:התוויה רפואית|medical indications]] and professional medical opinions
 
| מידע = The health plans are required by law to provide the medications included in [[The Healthcare Basket|the healthcare basket]] to policyholders, subject to relevant [[:he:התוויה רפואית|medical indications]] and professional medical opinions
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<!--
 
<!--
 
| חשוב = Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket-->
 
| חשוב = Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket-->
| פיצוי = [[Definition of Chronic Illness|Chronically Ill Patients]], are exempt from paying a co-payment for medications included in the Healthcare basket, only on amounts [[Medication Payment Ceiling for the Chronically Ill|Above the ceiling]].
+
| פיצוי = [[Definition of Chronic Illness|Chronically Ill Patients]], are exempt from paying a co-payment for medications included in the Healthcare basket, on amounts [[Medication Payment Ceiling for the Chronically Ill|exceeding the payment ceiling]]
 
| שאלה  = <!-- דוגמה: שאלה -->
 
| שאלה  = <!-- דוגמה: שאלה -->
| 2חשוב =  If a medication is not included in the health basket, it may be obtained by other means for more information see [[:he:מדריך להשגת תרופות שאינן בסל הבריאות| Guide for obtaining medications not included in the Healthcare basket]].
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| 2חשוב =  If a medication is not included in the health basket, it may be obtained in other ways.  For more information see the [[:he:מדריך להשגת תרופות שאינן בסל הבריאות|Guide for obtaining medications not included in the Healthcare basket]]
| ממשל  =  The list of [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|medications included in the health care basket]] is a detailed list that is updated each year.
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| ממשל  =  The list of medications included in the health care basket is a closed list, detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|ordinance]] and is updated each year
 +
}}
 
}}
 
}}
{{תקציר/סיום}}
 
 
{{טפסים
 
{{טפסים
 
| 1 =  
 
| 1 =  
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}}
 
}}
 
{{ראו גם  
 
{{ראו גם  
| [[The Healthcare Basket]]
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| [[:he:פטורים והנחות ברכישת תרופות|Exemptions and Discounts on Medications]]
 
| [[Health and Illness]]
 
| [[Health and Illness]]
| [[Submitting a Request to Include Treatments or Medications in the Healthcare Basket]]
 
 
| [[Obtaining a Specific Brand-Name Drug]]
 
| [[Obtaining a Specific Brand-Name Drug]]
 
| [[Obtaining a Specific Generic Drug]]
 
| [[Obtaining a Specific Generic Drug]]
 +
| [[:he:מדריך להשגת תרופות שאינן בסל הבריאות|Guide to Obtaining Medications not included in the Healthcare Basket]]
 
}}
 
}}
 
{{עצם העניין/סיום}}
 
{{עצם העניין/סיום}}
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* The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions.
 
* The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions.
 
* By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket.
 
* By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket.
* The health plans are not required to provided medications not included in the healthcare basket, but they may do so. Accordingly, it is possible that one health plan may supply a specific medication not included in the healthcare basket, while another health plan does not do so. In such a case, a policyholder may choose to switch to a health plan that has decided to supply a specific medication.
+
<!--* The health plans are not required to provided medications not included in the healthcare basket, but they may do so. Accordingly, it is possible that one health plan may supply a specific medication not included in the healthcare basket, while another health plan does not do so. In such a case, a policyholder may choose to switch to a health plan that has decided to supply a specific medication.-->
*[[Definition of Chronic Illness|Chronically Ill Patients]], are exempt from paying a co-payment for medications included in the Healthcare basket, only on amounts [[Medication Payment Ceiling for the Chronically Ill|Above the ceiling]].
 
 
* The co-payments required for specific services and medications are not the same in all health plans, so one health plan may take a larger or smaller co-payment for an identical service or medication than a different health plan.
 
* The co-payments required for specific services and medications are not the same in all health plans, so one health plan may take a larger or smaller co-payment for an identical service or medication than a different health plan.
* Policyholders may find out if a specific medication is included in the healthcare basket by reviewing the law or information published by the Ministry of Health.
+
*[[Definition of Chronic Illness|Chronically Ill Patients]], are exempt from paying a co-payment for medications included in the Healthcare basket, on amounts [[Medication Payment Ceiling for the Chronically Ill|exceeding the payment ceiling]].
* The list of medications included in the basket is closed and updated every year. Any public or private entity (i.e. patients, patient organizations, doctors, companies, etc.) may submit a request to add new medications to the healthcare services basket.
+
* Policyholders may find out if a specific medication is included in the healthcare basket by reviewing the law or information published by the [[:he:משרד הבריאות|Ministry of Health]].
 +
* The list of medications included in the basket is closed and is updated every year. Any public or private entity (i.e. patients, patient organizations, doctors, companies, etc.) may submit a request to add new medications to the healthcare services basket.
  
 
== Who is Eligible? == <!--מי זכאי-->
 
== Who is Eligible? == <!--מי זכאי-->
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== Medications Included in the Healthcare Basket ==
 
== Medications Included in the Healthcare Basket ==
* Information regarding the medications included in the healthcare basket can be found on the [https://www.old.health.gov.il/units/pharmacy/trufot/abc.asp?Sr_Type=SAL&safa=h Ministry of Health and health plans' websites.]
+
* Information regarding the medications included in the healthcare basket can be found on the [https://www.old.health.gov.il/units/pharmacy/trufot/abc.asp?Sr_Type=SAL&safa=h Ministry of Health] and health plans' websites.
* Information is provided on these sites regarding if a given medication is included in the basket, what the medical indications for its use are, if it may be acquired over the counter, and if a co-payment is required.  
+
*On these sites you can determine if a specific medication is included in the basket, what the medical indications for its use are, if it may be acquired over the counter, and if a co-payment is required.  
* The Ministry of Health website:
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* Information on the Ministry of Health website:
** [http://www.old.health.gov.il/units/pharmacy/trufot/index.asp?safa=e The Ministry of Health's medications database '''in English''']
+
** [https://data.health.gov.il/drugs/index.html#/byDrug The Ministry of Health's medications database]
 
** [http://www.health.gov.il/Subjects/Finance/DrugPrice/Pages/default.aspx Prescription medications price listing on the Ministry of Health website]
 
** [http://www.health.gov.il/Subjects/Finance/DrugPrice/Pages/default.aspx Prescription medications price listing on the Ministry of Health website]
 
** [http://www.health.gov.il/Subjects/Finance/Pages/OTC.aspx Non-prescription medications price listing on the Ministry of Health website]
 
** [http://www.health.gov.il/Subjects/Finance/Pages/OTC.aspx Non-prescription medications price listing on the Ministry of Health website]
* Health plan websites:
+
* Information on the health plan websites:
** Maccabi Health Services - [http://www.maccabi4u.co.il/443-he/Maccabi.aspx Co-payments for medications]
+
** Maccabi - [http://www.maccabi4u.co.il/443-he/Maccabi.aspx Co-payments for medications]
 
** Leumit Health Fund - [http://www.leumit.co.il/heb/rights/search/deductible/ Medication fees]
 
** Leumit Health Fund - [http://www.leumit.co.il/heb/rights/search/deductible/ Medication fees]
** Meuhedet Health Services - [https://www.meuhedet.co.il/meuhedet/views/engine?rnd=0.82017924921742&templateName=menu.txt&idorItemId=topMenu&menuBarView=menu&menuBarSubjectParam=1211196727562&menuBarStartMenuParam=subSubject&topMenuId=11&menuBarOpenCategoryParam=&mainView=article&mainId=&mainSubjectParam=1211196727562 Co-payments and exemptions]
+
<!--** Meuhedet Health Services - [https://www.meuhedet.co.il/meuhedet/views/engine?rnd=0.82017924921742&templateName=menu.txt&idorItemId=topMenu&menuBarView=menu&menuBarSubjectParam=1211196727562&menuBarStartMenuParam=subSubject&topMenuId=11&menuBarOpenCategoryParam=&mainView=article&mainId=&mainSubjectParam=1211196727562 Co-payments and exemptions]-->
** Clalit Health Services - [http://www.clalit.co.il/he/info/services/Pages/default.aspx Medication fees]
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** Clalit - [https://www.clalit.co.il/he/info/about_site/Pages/sherutim_betashlum.aspx Medication fees]
  
 
==Administrative Approval for Treatment with a Medication Included in the Healthcare Basket==
 
==Administrative Approval for Treatment with a Medication Included in the Healthcare Basket==
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* Accordingly, it is possible that one health plan may supply a certain medication even if it is not included in basket, while another health plan may choose not to.
 
* Accordingly, it is possible that one health plan may supply a certain medication even if it is not included in basket, while another health plan may choose not to.
 
* In such a case, a policyholder desiring a specific medication not included in the basket but offered by one health plan and not another may switch to a health plan offering the desired medication.
 
* In such a case, a policyholder desiring a specific medication not included in the basket but offered by one health plan and not another may switch to a health plan offering the desired medication.
* '''If a medication is not included in the health care basket, it maybe be obtained by other means. [[:he:מדריך להשגת תרופות שאינן בסל הבריאות|For more information]]'''
+
* '''If a medication is not included in the health care basket, it maybe be obtained by other means. For more information see the [[:he:מדריך להשגת תרופות שאינן בסל הבריאות|guide to obtaining medications not included in the healthcare basket.]]'''
  
 
== Submitting a Complaint regarding Non-Provision of a Medication ==
 
== Submitting a Complaint regarding Non-Provision of a Medication ==
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== Please Note == <!--חשוב לדעת-->
 
== Please Note == <!--חשוב לדעת-->
* The list of medications included in the basket is detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order (Medications in the Healthcare Services Basket)]]. In most cases, the medications appear by their generic name (according to the active ingredient). Accordingly, under the generic name, there may be a number of commercial names for the drug, even if they do not explicitly appear in the Order.
+
* The updated list of medications included in the healthcare basket is detailed in the [[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order (Medications in the Healthcare Services Basket), 1995]]. In most cases, the medications appear by their generic name (according to the active ingredient). Accordingly, under the generic name, there may be a number of commercial names for the drug, even if they do not explicitly appear in the Order.
 
* All medications marketed in Israel must appear in the "Registry of Medical Products in Israel" (פנקס התכשירים הרפואיים בישראל) before being marketed. Registration and approval of a specification medication and its medical indications does not mean that it is included in the healthcare services basket.
 
* All medications marketed in Israel must appear in the "Registry of Medical Products in Israel" (פנקס התכשירים הרפואיים בישראל) before being marketed. Registration and approval of a specification medication and its medical indications does not mean that it is included in the healthcare services basket.
*<!-- Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket.--> Policyholders must obtain a [[Obtaining a Payment Voucher (Form 17) from the Health Plan|letter of financial obligation/payment voucher (Form 17, also know as התחייבות) from their health plan]], which covers all medications and services they may require during hospitalization according to the relevant medical opinions.  <!--whether they are included in the healthcare basket or not.-->
+
*<!-- Hospitals are required to supply all necessary medications to hospitalized patients according to the attending physician's professional opinion, even if the medications are not included in the healthcare basket.-->When being hospitalized, policyholders must obtain a [[Obtaining a Payment Voucher (Form 17) from the Health Plan|letter of financial obligation/payment voucher (Form 17, also know as התחייבות) from their health plan]], which covers all medications and services they may require during hospitalization according to the relevant medical opinions.  <!--whether they are included in the healthcare basket or not.-->
* If the medication is not included in the healthcare basket, payment can be obtained via other means. For more information see [[:he:מדריך להשגת תרופות שאינן בסל הבריאות| Guide to Accessing Medications not Included in the Healthcare Basket]].
+
* If the medication is not included in the healthcare basket, it can be obtained via other means. For more information see [[:he:מדריך להשגת תרופות שאינן בסל הבריאות| Guide to Accessing Medications not Included in the Healthcare Basket]].
  
 
== Court Rulings == <!--פסקי דין-->
 
== Court Rulings == <!--פסקי דין-->
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== Government Agencies == <!--גורמי ממשל-->
 
== Government Agencies == <!--גורמי ממשל-->
* [[:he:משרד הבריאות|The Ministry of Health]]
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{{הטמעת כותרת|Health and Illness#Government Agencies}}
* [[:he:נציבות קבילות הציבור לחוק ביטוח בריאות ממלכתי|The National Health Insurance Law Ombudsman]]
+
 
* [[:he:המוסד לביטוח לאומי|The National Insurance Institute]]
 
 
== Laws and Regulations == <!--חקיקה ונהלים-->
 
== Laws and Regulations == <!--חקיקה ונהלים-->
[[:he:חוק ביטוח בריאות ממלכתי|The National Health Insurance Law]]
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{{הטמעת כותרת|The Healthcare Basket#Laws & Regulations}}
[[:he:צו ביטוח בריאות ממלכתי (תרופות בסל שירותי הבריאות)|National Health Insurance Order (Medications in the Healthcare Services Basket)]]
+
* [http://www.health.gov.il/hozer/sbn03_10.pdf Health Plan and Additional Health Services Supervision Division Circular 3/2010 from 16.03.2010] - Prior approval processes for the provision of treatment with medications included in the healthcare basket
  
 
== Additional Publications == <!--הרחבות ופרסומים-->
 
== Additional Publications == <!--הרחבות ופרסומים-->
* [http://www.health.gov.il/hozer/sbn03_10.pdf Health Plan and Additional Health Services Supervision Division Circular 3/2010 from 16.03.2010] - Prior approval processes for the provision of treatment with medications included in the healthcare basket
 
 
* [http://www.patients-rights.org/medicins.html Medications] on [[:he:האגודה לזכויות החולה בישראל|The Society for Patients Rights in Israel]]'s website
 
* [http://www.patients-rights.org/medicins.html Medications] on [[:he:האגודה לזכויות החולה בישראל|The Society for Patients Rights in Israel]]'s website
* [http://www.old.health.gov.il/Download/pages/trufotSal2011.pdf Listing of medications included in the 2011 healthcare basket] on the Ministry of Health website
 
* [http://www.health.gov.il/hozer/mk01_2012.pdf Ministry of Health Director Circular 1/12 from 10.01.2012] - Expansion of the healthcare services basket for 2012
 
 
* [http://www.clalit.co.il/he/medical/pharmacy/Pages/Medicine_guide.aspx Clalit Health Services Medications Guide]
 
* [http://www.clalit.co.il/he/medical/pharmacy/Pages/Medicine_guide.aspx Clalit Health Services Medications Guide]
 
*[http://www.mof.gov.il/hon/Consumer-Information/Consumer-Insurance/Pages/HealthInsuranceGuid.aspx#skip Health Insurance Guide for Medications] from the website of the Capital Market Authority, Insurance and Savings
 
*[http://www.mof.gov.il/hon/Consumer-Information/Consumer-Insurance/Pages/HealthInsuranceGuid.aspx#skip Health Insurance Guide for Medications] from the website of the Capital Market Authority, Insurance and Savings
  
== Sources == <!--מקורות-->
+
== Credits == <!--מקורות-->
 
* Original information provided by the [[:he:המרכז הקליני מזו"ר - המשפט למען זכויות החולה בישראל|Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel]].
 
* Original information provided by the [[:he:המרכז הקליני מזו"ר - המשפט למען זכויות החולה בישראל|Mazor Clinical Center - Providing Legal Advice Regarding Patients Rights in Israel]].
* Original translation by [[AACI - Association of Americans and Canadians in Israel|AACI]]'s [[The Shira Pransky Project|Shira Pransky Project]].
+
* {{קרדיט/פרויקט שירה פרנסקי}}
<!--כותרת דמה עבור הטמעת כותרת. לא לגעת!
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==Metadata==
==endarticle==
 
כותרת דמה עבור הטמעת כותרת. לא לגעת!-->
 
 
   
 
   
 
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[[Category:Rights]]
 
[[Category:Rights]]
  
[[HE:תרופות בסל הבריאות]]
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[[he:תרופות בסל הבריאות]]

Latest revision as of 23:02, 14 January 2019

Introduction:

The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions
Chronically Ill Patients, are exempt from paying a co-payment for medications included in the Healthcare basket, on amounts exceeding the payment ceiling
If a medication is not included in the health basket, it may be obtained in other ways. For more information see the Guide for obtaining medications not included in the Healthcare basket
The list of medications included in the health care basket is a closed list, detailed in the ordinance and is updated each year


The list of medications included in the basket according to The National Health Insurance Law is detailed in the National Health Insurance Ordinance (Medications in the Healthcare Services Basket).

  • The health plans are required by law to provide the medications included in the healthcare basket to policyholders, subject to relevant medical indications and professional medical opinions.
  • By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket.
  • The co-payments required for specific services and medications are not the same in all health plans, so one health plan may take a larger or smaller co-payment for an identical service or medication than a different health plan.
  • Chronically Ill Patients, are exempt from paying a co-payment for medications included in the Healthcare basket, on amounts exceeding the payment ceiling.
  • Policyholders may find out if a specific medication is included in the healthcare basket by reviewing the law or information published by the Ministry of Health.
  • The list of medications included in the basket is closed and is updated every year. Any public or private entity (i.e. patients, patient organizations, doctors, companies, etc.) may submit a request to add new medications to the healthcare services basket.

Who is Eligible?

  • Anyone insured according to The National Health Insurance Law.

How to Claim It?

  • Obtaining medications included in the healthcare basket is subject to relevant medical indications and a professional medical opinion of the attending physician.

Medications Included in the Healthcare Basket

Administrative Approval for Treatment with a Medication Included in the Healthcare Basket

  • The health plans sometimes make provision of treatment with specific medications contingent on prior administrative approval (approval that is not from the attending physician).
  • Due to the fact that this approval process is liable to delay provision of essential treatment, the Ministry of Health has determined that health plans requesting to make provision of medications conditional may do so according to the following conditions:
  • The approval is limited to a reduced number of medications for non-urgent treatments.
  • A listing of the medications is published on the health plan's website.
  • The conditional administrative approval is only for the the drug treatment's initial prescription.
  • A response will be provided to the patient no more than four days from the date the request was submitted by the attending physician. If a response is not received in this period of time, it will be considered to be approval of the request.
  • The attending physician is responsible for making sure approval is obtained.
  • Any refusal of administrative approval must be explained and sent to the patient in writing.

Supply of Medications Not in the Healthcare Basket

  • The health plans are not required to supply medications not included in the healthcare services basket to policyholders, but they may choose to do so.
  • Accordingly, it is possible that one health plan may supply a certain medication even if it is not included in basket, while another health plan may choose not to.
  • In such a case, a policyholder desiring a specific medication not included in the basket but offered by one health plan and not another may switch to a health plan offering the desired medication.
  • If a medication is not included in the health care basket, it maybe be obtained by other means. For more information see the guide to obtaining medications not included in the healthcare basket.

Submitting a Complaint regarding Non-Provision of a Medication

Please Note

Court Rulings

Aid Organizations

  • For a comprehensive categorized listing of healthcare organizations offering assistance and support, click here.

Government Agencies


Laws and Regulations

Additional Publications

Credits