Sosiaali- ja terveysministeriön asetus sairausvakuutuslain 5 luvun 1 §:n 2 momentissa tarkoitettujen lääketieteellisin perustein välttämättömien, ilman lääkemääräystä myytävien lääkevalmisteiden korvaamisesta
Purpose
The decree lists specific over-the-counter medicines by brand name and package size that are reimbursable under health insurance for severe and long-term illnesses.
Analysis
The decree lists medicines by brand name (Combizym, Humulin, Lamisil etc.) instead of active ingredient. Every new generic or biosimilar requires an amendment before it becomes reimbursable – this slows market entry for generics and sustains higher prices. The list also contains products that have left the market (e.g. Humutard, several old insulins). Fix: convert the list to active-ingredient-based (e.g. 'sucralfate' instead of Antepsin), so new products are automatically reimbursable without amending the decree. Estimated savings: Kela reimbursement in these groups is roughly 5–15 M€/year; generic competition will reduce prices 10–20%, saving approximately 1–3 M€/year.
Verdict reasoning
The decree lists medicines by brand name (Combizym, Humulin, Lamisil etc.) instead of active ingredient. Every new generic or biosimilar requires an amendment before it becomes reimbursable – this slows market entry for generics and sustains higher prices. The list also contains products that have left the market (e.g. Humutard, several old insulins). Fix: convert the list to active-ingredient-based (e.g. 'sucralfate' instead of Antepsin), so new products are automatically reimbursable without amending the decree. Estimated savings: Kela reimbursement in these groups is roughly 5–15 M€/year; generic competition will reduce prices 10–20%, saving approximately 1–3 M€/year.
Other healthcare laws
Analysis by Claude Opus 4.6 AI. Estimates are indicative.