Prescriptions and Pharmacy Costs in Spain

The 2026 public co-payment rates

In the public system you pay part of the retail price (PVP) of each prescribed medicine. This is the aportación farmacéutica (pharmaceutical contribution), usually called the copago. It was set by Real Decreto-ley 16/2012 and is now in article 102 of the medicines law (Real Decreto Legislativo 1/2015).

Real Decreto-ley 11/2026 of 12 May rewrote those rules. It was published in the BOE on 13 May, took effect on 14 May 2026, and was validated by Congress on 28 May. Income is measured on the general and savings tax bases of your IRPF (Spanish income tax) return.

Working-age people and their beneficiaries

Social Security pensioners and their beneficiaries

The Ministry of Health says the reform does not raise anyone's percentage. Caps for working-age people on lower incomes are new.

Medicines with reduced contribution

Some medicines, mainly for chronic conditions, carry a reduced 10% contribution. The maximum was raised from €4.24 to €4.98. Real Decreto-ley 12/2026 then clarified that the €4.98 limit applies to each dispensation, not to each month (Laboral Social).

Why you may still be paying the old rates

The law changed in May, but your band has to be recalculated before your pharmacy charges the new rate. The Comunidad de Madrid (page updated 2 September 2026) explains that the INSS must first validate tax data and reassign each person's code. Until then, the previous percentages and caps continue on a transitional basis. It expects the update in late 2026; individual updates are normally made between October and December using the latest tax year.

The previous rules, as summarised by Cardioteca, were:

• working-age people: 40% under €18,000, 50% from €18,000 to €99,999 and 60% from €100,000, with no monthly caps
• pensioners: 10% with caps of €8.23 (under €18,000), €18.52 (€18,000 to €99,999) and 60% capped at €61.75 (€100,000 or more).

The biggest changes are for workers earning €18,000 to €59,999, whose rate falls from 50% to 45%, and pensioners earning €18,000 to €59,999, whose cap falls from €18.52 to €13.37.

Two worked examples

These use the new rules once your band has been updated:

• Pensioner, income €25,000, medicines with a PVP of €200 a month. 10% is €20, but the cap is €13.37, so you pay €13.37.
• Employee, income €30,000, medicines with a PVP of €100 a month. 45% is €45, which is below the €61.75 cap, so you pay €45. Under the old rules you would have paid €50.

Who pays nothing

The decree and the Ministry list these exempt groups:

• people receiving a non-contributory pension, the ingreso mínimo vital (minimum income) or a regional social integration income
• unemployed people who have lost their right to unemployment benefit, for as long as that lasts
• pensioners receiving the complemento por mínimos (the top-up for pensions below the legal minimum), a test that replaced the old income threshold
• treatment for a work accident or occupational disease
• children under 18 with a recognised disability of 33% or more
• people affected by toxic syndrome, and some people with disabilities under specific rules
• according to the Ministry, families receiving the complemento de ayuda para la infancia (child support supplement).

Under the decree's transitional rule, pensioners exempt under the old rules keep the exemption with annual income under €5,635 (€11,200 if they do not have to file a tax return).

Adults with a disability are not automatically exempt. The Madrid page points out that disability alone does not exempt adults in the Social Security system.

Monthly caps and refunds

Caps are monthly, but not every pharmacy applies them at the counter. The decree requires your autonomous community to refund anything above the cap at least every six months. Selectra's regional round-up reports that some regions, including Castilla y León, Murcia and the Comunitat Valenciana, stop charging electronic prescriptions once you reach the cap. Others refund later.

Caps do not follow you across regions. If you fill a prescription while away from your home region, you pay the full percentage and claim the excess back from your own health service with the receipt and a copy of the prescription.

How to check your band

Your band is linked to your health card as a TSI code. The Madrid table uses:

Your regional health app, your pharmacist or your health centre can tell you your code. If the code does not match your situation, for example a working-age code when you receive a pension, ask your health centre how to claim a correction. If you have not yet registered for the card, start with how to get a Spanish health card.

Private prescriptions and insurance

A prescription from a private doctor is not subsidised. Rastreator confirms you pay 100% of the price at the pharmacy, and that subsidised medicines need a prescription from a public-system doctor.

Most Spanish health policies exclude medicines you take at home. Adeslas Plena's general conditions, for example, exclude medicines "of any kind" except those given during a hospital stay, day hospital or outpatient surgery. This is one of the exclusions explained in what private health insurance doesn't cover.

Some insurers sell pharmacy cover as an add-on. Rastreator's January 2026 table:

If you also have public entitlement, it is often cheaper to get your public GP to prescribe long-term medicines than to pay for an add-on.

Convenio especial and private-only residents

The convenio especial gives access to public doctors and hospitals but not to subsidised medicines. The Ministry of Health states that outpatient medicines, orthoprosthetics and dietary products carry a 100% contribution. Budget for regular medication on top of the €60 or €157 monthly fee. See our convenio especial guide.

Residents with only private insurance, such as many non-lucrative visa holders, are in the same position: every prescription is at full price unless their policy refunds part of it. If you take regular medication, factor that in when you compare routes. Our page on healthcare for pensioners and early retirees covers the options.