The availability of medicines in general

In Denmark, medicines on a special list (essentially all prescription medicines) are covered up to a certain degree depending on the overall total expenditure on medication of a patient during a year.

• If the total expenditure on medicines in a year does not exceed DKK 480 (approx. € 63), the patient covers 100% of the drug costs.
• For total medicines expenditure between DKK 480 and DKK 1,165 (approx. € 156), the patient covers 50% of the costs.
• For total medicines expenditure between DKK 1,165 and DKK 2.730 (approx. € 366), the patient covers 25% of the costs.
• For total medicines expenditure above DKK 2,730, the patient covers 15% of the costs.

Nevertheless, for cases where there is a well documented need for extensive and permanent treatment, the reimbursement rate can go up to 100% of the part of the total co-payment which is in excess of DKK 3,520 (approx. €472).

Finally, in special cases the health service can contribute to medicines not on the list or contribute fully to medicines for dying persons. [1]

The availability of Alzheimer treatments

All anti-dementia drugs are available in Denmark and are part of the reimbursement system. Reimbursement is dependent on a prior authorisation by the Danish Medicines Agency according to the following procedure.

An application for reimbursement has to be sent to the Danish Medicines Agency and any doctor can apply for reimbursement for a patient. Nevertheless, reimbursement is only granted, if a specialist in neurology, psychiatry or geriatrics has made the diagnosis.

For patients with mild to moderate dementia a CT (or MR scan) of the brain has to be performed first. The physician also has to state that causes other than Alzheimer are excluded.

The system does not provide upper or lower MMSE limits for the treatment with different anti-dementia drugs, but reimbursement is dependent on a clinical grading. Reimbursement for donepezil, rivastigmine and galantamine is only granted to patients in mild to moderate stages and memantine to patients in moderate to severe stages.

The application has to be renewed every 12 to 15 months. Renewal of reimbursement of memantine depends on a statement by the physician that a continuous effect in the individual patient is still observed. There are no restrictions as to the access of people living alone or in nursing homes to available Alzheimer treatments.

[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