The availability of medicines in general

In Iceland, medicines are divided into 4 main categories depending on their type and category. Payments by patients for medicines can vary from 0 to 100% of their overall cost, again depending on the category of the medicine. Patients only pay this co-payment to the pharmacy with the rest of the costs being paid to pharmacies by the health insurance.

• Category 1: Essential medicines used for the treatment of life threatening and chronic conditions such as diabetes, cancer and psychotic disorders are reimbursed 100%.
• Category 2: Medicines of great therapeutic value for well defined and chronic diseases such as hypertension, asthma, psoriasis and depression are partly reimbursed
• Category 3: Medicines of lesser therapeutic value such as medicines for arthritis or hormone replacement therapy in menopause are also partly reimbursed
• Category 4: Medicines for which the indication is too broad or not well defined as well as medicines for minor conditions (tranquilisers, analgesics, antibiotics and lipid regulating drugs) are not generally reimbursed.

Medicines in categories 1, 2 and 3 are on the positive list, but products not on the positive list may be reimbursed in individual cases, when certain criteria are fulfilled[1].

The availability of Alzheimer treatments

All four anti-dementia drugs are available in Iceland. They are included in category 4 and are thus not part of the positive list. Nevertheless, reimbursement is possible under the following criteria.

People that have been diagnosed by a specialist can receive a special drug card which allows them to have their medicines reimbursed. For treatment with acetylcholinesterase inhibitors, the specialist needs to diagnose a patient with either Alzheimer’s disease or Lewy Body dementia according to the ICD 10 criteria. For treatment with memantine, patients need to score at least five points on the GDS (Global Deterioration Scale).

Although diagnosis needs to be done by a specialist, it is possible for general practitioners to prescribe treatment with either class of drugs. A follow-up of the patient needs to be done every year and the drug card will not be renewed if a patient has deteriorated by more than two points on their MMSE scores and if carers do not believe the medicines had any results.

The Icelandic reimbursement system does not have any specific restrictions for the reimbursement of Alzheimer treatments for people living alone or in nursing homes.

[1] European Commission (2006): MISSOC – Mutual information system on social protection : Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland : Comparative tables