(Administrative Approval for Treatment with a Medication Included in the Healthcare Basket)
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==Administrative Approval for Treatment with a Medication 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 due so under the following conditions:
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*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.
 
:*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.
 
:*A listing of the medications is published on the health plan's website.
:*The conditional administrative approval is only for the initial prescription the drug treatment.
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:*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.
 
:*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.
 
*The attending physician is responsible for making sure approval is obtained.

Revision as of 17:05, 2 June 2013

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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 a professional medical opinion
The list of medications included in the basket is closed, detailed in the National Health Insurance Order, and updated every year
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
By law, the health plans are permitted to collect a co-payment for medications included in the healthcare basket
  • The list of medications included in the basket is detailed in the National Health Insurance Order (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 a professional medical opinion.
  • 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 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.
  • 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.

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Who is Eligible?

How to Claim It?

  • Information regarding the medications included in the healthcare basket can be found on the Ministry of Health website and through the health plans.
  • Information is provided regarding if the medications are 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.

Useful Websites:

Co-Payment Amounts

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.

Please Note

  • The list of medications included in the basket is detailed in the 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.
  • 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. For hospitalization, policyholders receive a 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 opinion, whether they are included in the healthcare basket or not.

Legal Precedents

Aid Organizations

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

Government Agencies


Laws and Regulations

The National Health Insurance Law National Health Insurance Order (Medications in the Healthcare Services Basket)

Additional Publications

Sources

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