Health and medicine
Whether a medicine is covered by the State reimbursement programme: what to do under Georgian law
Who receives free medicines under the State programme, which disease groups and drugs are covered, and what to do if a drug is not on the list.
What to do
- The category comes first: without it the drug is not free. Recipients: families in the vulnerable-households database with a score not above 100,000; persons of pensionable age (women from 60, men from 65) (Decree No. 36, as amended 2020, Art. 1, para. 3⁶ of Annex 1); children with disability status, persons with severe or significant disability, veterans (Decree No. 36, as amended 2020, Art. 1, para. 3⁶ of Annex 1); persons with Parkinson’s disease or epilepsy, regardless of age and score (Decree No. 36, as amended 2020, Art. 1, para. 3⁶ of Annex 1).
- Then the disease and the drug: the medicines component of the Universal Healthcare Programme covers the groups: chronic cardiovascular and pulmonary diseases, thyroid disease, type 2 diabetes, glaucoma, Parkinson’s disease and epilepsy (Decree No. 36, as amended 01.2024, Art. 1, Annex 1.9); specific drugs are covered only if they are on the list approved by the implementing agency’s act (Decree No. 36, as amended 01.2024, Art. 1, Annex 1.9). Check the trade name (e.g. Forxiga) against the agency’s current list; do not rely on memory.
- Payment and dispensing: drugs on the list are reimbursed in full, without co-payment (Decree No. 36, as amended 02.2024, Art. 1, Annex 1.9); charging the recipient any other payment is prohibited (Decree No. 36, as amended 2020, Art. 1, Annex 1.9); dispensing is against an electronic voucher at a pharmacy participating in the programme (Decree No. 36, as amended 2020, Art. 1, Annex 1.9); the implementing agency is the National Health Agency (Decree on the 2026 State Health Programmes, Art. 6).
- Insulin is a separate programme: insulin and analogues for persons with diabetes aged 18 and over are procured under the “Diabetes Management” programme (Decree No. 474, Art. 3, Annex “Diabetes”); for citizens and persons permanently residing in Georgia who have diabetes (Decree No. 474, Art. 2, Annex “Diabetes”); free of charge, without co-payment (Decree No. 474, Art. 4, Annex “Diabetes”). Basis: the law obliges the State to provide vital medicines for permanent replacement therapy (Law of Georgia on Healthcare, Art. 85).
- Not on the list or not within the categories: treatment that is not covered may be paid for by the “Reference Services” programme on the decision of the inter-agency commission (Decree No. 474, Art. 4, Annex “Reference Services”); municipal assistance; a written refusal by the agency is challenged by an administrative complaint.
- Where to apply: National Health Agency; participating pharmacy; family doctor.
- Documents to prepare: identity document; doctor’s prescription with the diagnosis; certificate of disability or veteran status, or the vulnerability score.
- Pitfalls: not all medicines for a disease are free, only drugs on the list; a person below pensionable age without status is not entitled to the component (except for Parkinson’s disease and epilepsy); the implementing agency is not the Social Service Agency.
Be sure to check
- who receives free medicines (pensionable age, vulnerability score up to 100,000, disability, veterans; Parkinson’s disease and epilepsy: all citizens regardless of age and score)
- which disease groups are covered, and that each specific drug is checked against the agency’s list
- drugs on the list: in full, without co-payment, at a participating pharmacy against an electronic voucher
- insulin: separately under the “Diabetes Management” programme, free of charge
- what to do if a drug is not on the list (reference commission, municipality, appeal of a refusal)