The Nicosia Administrative Court, in a decision issued on Wednesday, annulled a previous rejection by the Health Insurance Organization of a patient's request for the execution of a doctor's prescription through the General Health System, on the grounds that the doctor who prescribed it was not contracted with the General Health System.
According to the text of the decision, proceeding to examine the substance of the arguments, the Court states that the issue at issue is whether, under the relevant legislation, it is a prerequisite for the provision of pharmaceutical products to a beneficiary that the prescription be made by a medical staff or specialist contracted with the defendant Organization.
As stated, according to the contested administrative decision, the defendant in the application rejected the applicant's request to receive the necessary pharmaceutical products within the framework of the General Health Insurance System, on the grounds that the said medicines had not been prescribed by a doctor contracted with the Organization, although it is an admissible fact that they were within the list of pharmaceutical products, the cost of which is covered by the Organization, within the framework of the system.
It is added that among the healthcare services provided by the system, there are both healthcare services from personal doctors and healthcare services from specialist doctors, as well as the provision of necessary pharmaceutical products, medical devices and sanitary items (included in the list of expenses covered by the Organization through the system), which are "administered based on a prescription issued by a doctor or dentist".
"It is not accidental that the provision of health care services, in the provisions of article 23 of the Law, is determined by doctors who are distinguished into two categories (personal and specialist), without, however, making such a distinction for the provision of necessary pharmaceutical products, for which service a prescription issued by a doctor is required," it is noted below.
"Consequently, the provider of pharmaceutical products is the pharmacist, who, according to the provisions of article 30(b), must be contracted with the Organization, while such an obligation does not appear to be explicitly required for the issuer of the prescription, only that it be issued by a doctor. Without reference, either to staff or to a specialist," it is added in this regard.
It is noted that based on the above, the pharmacist contracted with the Organization "acts as a provider of healthcare services, in relation to the necessary pharmaceutical products, executing a prescription issued by a "doctor" or dentist and, in addition and in compliance with the provisions of subparagraph (a) of paragraph (1), also acts as a provider of healthcare services for the administration of pharmaceutical products, following a prescription issued by personal and specialist doctors".
"Therefore, according to the literal interpretation of all the above-mentioned legislative provisions, if the beneficiary chooses to receive health care services from a personal physician or specialist, then the system covers the cost of their remuneration, as well as the necessary pharmaceutical products, medical devices and sanitary items, based on the prescription that the personal or specialist physician will issue, from a pharmacist contracted for this purpose," it is underlined.
It is added that if the beneficiary chooses not to make use of health care services from a personal or specialist doctor, but from a doctor of his choice, then the cost of his remuneration is covered by the beneficiary himself, while according to the provisions of article 22(d), as it is worded, "the necessary pharmaceutical products, medical devices and sanitary items, within the system's list, based on a prescription issued by the doctor of the beneficiary's choice, are covered by the system, provided that the prescription is filled by a contracted pharmacist".
Based on the above, the Court concludes that "the interpretation given by the respondent Organization was misleading, by adding words and combining provisions of the legislation, in order to achieve an interpretation that is inconsistent with the rendering of the simple grammatical meaning of the word "physician", as referred to in article 22(2)(d) of the Law, with regard to the independent and autonomous provision of health care services, which concerns the issuance of a prescription by a "physician" for the provision of the necessary pharmaceutical products, medical devices and sanitary items, regardless of the use by the beneficiary and the health care services by a personal or specialist doctor, according to subsections (2)(a) and (b) of the same article".
"The defendant Organization, under error regarding the Law, rejected the applicant's request, judging that in order to obtain the necessary pharmaceutical products within the framework of the General Health Insurance, they should be prescribed by a provider/physician contracted with the Organization, as such an obligation does not arise from the provisions of article 22(2)(d), provisions that regulate the independent provision of healthcare services, with regard to the provision of necessary pharmaceutical products, always within the list of the General Health Insurance, based on a prescription issued by a physician, regardless of whether or not he is contracted with the Organization, provided that the prescription will be executed by a contracted pharmacist," it is noted.
"For the above reasons, the appeal succeeds and the contested decision is annulled, based on Article 146.4(b) of the Constitution. The application is awarded in favor of the applicant and against the defendant in the amount of €2.000 plus VAT," the decision concludes.
