CNOPS — Guide to reimbursable medicines: practical guide

Quick answer. The CNOPS “Medicines” service helps users check whether a medicine is included among products reimbursable or covered by Mandatory Health Insurance (AMO) and consult the related reference information. CNOPS states that a medicine must appear on the regulatory list of reimbursable medicines to qualify for reimbursement.

Price paid and reimbursement basis may differ

CNOPS distinguishes the Public Sale Price (PPV) from the price or basis used to calculate reimbursement. For ordinary outpatient medicines, the rules described by CNOPS may use the price of the generic equivalent as the reimbursement basis when one exists. The amount reimbursed should therefore not be estimated simply by applying a percentage to the price shown on a receipt.

How to check a medicine before preparing the claim

1. use the official CNOPS medicines search engine;
2. search for the relevant product and verify its status;
3. check the PPV and reimbursement basis when those values are displayed;
4. if the treatment concerns a long-term or costly condition, separately verify exemption or coverage rules;
5. do not use administrative coverage information as a substitute for a medical prescription or treatment decision.

Outpatient reimbursement file

CNOPS indicates that a file containing medicines must in particular include the care sheet and a named, dated, signed and stamped prescription containing the required prescribing information. CNOPS also requests the medicine barcodes, or the box where a barcode is unavailable. Medicines paid for during hospitalisation can require additional evidence.

Long-term conditions and third-party payment

For certain long-term or costly conditions, an agreement for exemption from the patient contribution can change the applicable coverage. CNOPS also describes arrangements for some costly medicines through contracted pharmacies. Do not confuse ordinary outpatient reimbursement with third-party payment: check the mechanism that corresponds to your approval and medicine.

Where to file and track?

For outpatient reimbursement, CNOPS states that the file is submitted to the relevant mutual organisation within the applicable regulatory deadline. For general tracking of your situation, also consult CNOPS — insured member area. The binding coverage rules remain those published by CNOPS and the AMO texts.

Sources checked on 7 September 2026

• CNOPS — reimbursable medicines
• CNOPS — medicine search engine
• CNOPS — PPV, reimbursement basis and third-party payment

Important: this page explains the administrative reimbursement process. For any decision about treatment or substitution, consult a health professional.

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