Do a civil disability status or an exemption due to a chronic illness entitle me to cover for my treatment?

I have a recognised civil disability due to a chronic condition and am being treated with a specific medicinal formulation that ensures my condition remains stable and gives me a good quality of life, whilst avoiding the side effects associated with conventional treatment. However, whilst the standard version of the treatment is covered by the National Health Service, the formulation I take is classified as being entirely at the patient’s own expense. In recent months, the price I pay at the chemist’s has risen significantly, making it a recurring expense that is difficult to sustain. Does recognition of civil disability or exemption for a chronic illness entitle me to coverage of this cost, or are there channels through which I can apply for public funding? Maria M.

Her situation is typical of many people with a chronic illness. Her doctor has prescribed the treatment that works best for her, but the Italian Medicines Agency (AIFA) has classified that formulation as falling into a category that the National Health Service does not reimburse.

AIFA classifies medicines it considers essential for serious or chronic conditions as Category A. These are paid for by the National Health Service, subject to any regional co-payment or the price difference compared with the generic version. Category C medicines, on the other hand, are paid for in full by the person purchasing them. The price is set freely by the manufacturer, who may update it periodically.

The exemption for chronic conditions and civil disability exempts you from the patient contribution for consultations, tests and Category A medicines as set out in the Essential Levels of Care (LEA). This does not apply to Category C medicines, regardless of your income, degree of disability or exemption code. This is the point on which we receive the most enquiries.

However, if you cannot revert to the standard formulation without losing the balance you have achieved, there are a few options available to you. The first is to consult your specialist. If you are being treated at a public or NHS-affiliated facility, ask them for a clinical report explaining why the reimbursed version is not suitable for you: whether it is ineffective, you cannot tolerate it, or it has caused adverse effects. With this report, you can submit a request to your local health authority’s pharmaceutical service to receive the medicine in your name, with the cost covered by the health authority. Please be aware that this is not a guaranteed right: the cost falls outside the Essential Levels of Care (LEA), and whilst some local health authorities accept these requests, others reject them.