Spain introduces progressive pharmaceutical co‑payment tiers under new decree

The Spanish government approved a Royal Decree‑Law to reform the co‑payment system for prescription medicines, which took effect on Thursday. The reform expands income‑based contribution brackets for active workers from three to six tiers and adds a fourth tier for pensioners, introducing monthly caps on out‑of‑pocket spending for lower‑income groups.

For workers earning under €9,000 a year, the co‑payment is set at 40% with an €8.23 monthly limit; incomes between €9,000 and €17,999 also face a 40% rate with an €18.52 cap; €18,000‑€34,999 are charged 45% with a €61.75 ceiling; higher earners retain the existing 45%, 50% and 60% rates without caps. Pensioners keep a 10% rate for incomes below €18,000 (cap €8.23) and for incomes up to €59,999 (cap €13.37), with the same 10% rate and €18.52 cap for €60,000‑€99,999, while those above €100,000 pay 60% with a €61.75 cap. The reform is expected to cost about €265 million, roughly 2 % of projected pharmaceutical spending in 2025.

Commentary notes that the decree focuses solely on co‑payment changes, omitting other pending reforms such as price‑transparency measures or updates to disability rights legislation. The new structure lowers the contribution rate for incomes between €18,000 and €60,000 from 50% to 45% and does not raise the maximum rate for high‑income groups, unlike earlier drafts that proposed rates up to 65%.