New prescription co-payment 2026: how much do you pay and get back?

What changed with Royal Decree-Law 11/2026, how much you pay for your medicines according to your income, how to check your band and when overpayments are refunded.

Under the new prescription co-payment, what you pay for medicines prescribed by the Spanish National Health System depends on whether you are working or a pensioner and on your income, and in many cases it has a monthly limit. If you pay more than that cap in a month, your region has to refund the difference.

If you take long-term medication, understanding your band helps you plan your spending and check that you are charged correctly. Here are the figures in the law and the steps to check them.

What has changed with Royal Decree-Law 11/2026?

The reform, published in the Official State Gazette (BOE) on 13 May 2026 and in force from the following day, makes the co-payment more progressive. Working people move from three to six bands, with monthly caps for the first time for low and middle incomes, and pensioners move from three to four bands.

• The income that counts is the general and savings taxable base in your income tax (IRPF) return.
• Medicines in the reduced contribution groups (many of them for long-term conditions) stay at 10% with a maximum of 4.98 euros. A later royal decree-law, of 26 May 2026, made clear that this maximum applies per pack.
• Exempt groups still include people receiving a non-contributory pension or the minimum living income, unemployed people who have lost their benefit and pensioners receiving the minimum pension top-up.
• Members of the civil service mutual funds MUFACE, ISFAS and MUGEJU generally keep paying 30%.

If you want to go over what the co-payment is from the start, read what the prescription co-payment is.

How much do you pay according to your income and situation?

You pay a percentage of the retail price of each publicly funded medicine, from 10% to 60%, and in several bands that spending has a monthly limit. These are the figures in article 102 of the Spanish medicines law after the reform:

To work out what it means for you each month and how to reduce it, see our guide on how much your medication costs.

How do you find out which band applies to you?

Your contribution level is set by the National Social Security Institute (INSS) using income data, and it is recorded on your health card with a code (TSI). You do not have to submit any document to prove your income.

• In your region's health app or online health record: many show your percentage and monthly cap in the administrative details.
• At the top of your treatment sheet or report from the electronic prescription system, in some regions.
• At the pharmacy, when you show your health card, or at the user services desk of your health centre.

An important detail: according to the Community of Madrid, applying the new percentages to each person requires the INSS to reassign contribution codes, which is usually done once a year, between October and December, and in 2026 will use 2025 income data. Until then, the previous percentages and caps continue to apply on a transitional basis. That is why it is worth checking your band at the end of the year. You can check it alongside your treatments, as we explain in electronic prescriptions on your phone.

When are you entitled to a refund and how do you claim it?

The law says that anything you pay above your monthly cap is refunded by your region, at least every six months. In practice, in many regions the electronic prescription system applies the limit automatically at the pharmacy, so you usually do not have to do anything.

You may need to claim it yourself in these cases:

1. If you collect medication at a pharmacy in another region: your caps do not apply there and you pay the full percentage. When you return, you can claim back whatever exceeds your cap.
2. If you have been charged incorrectly, for example under a band that does not apply to you.

The claim is usually made on the online portal of your regional health service, attaching your receipts. Always keep your pharmacy receipts. If you think your band is wrong, ask first at your pharmacy or at the user services desk of your health centre. If you have a recognised disability, also check whether you are entitled to an exemption.

A practical example: Luis and his summer in another region

Let us take the case of Luis, 59, a working maintenance technician with an income of 28,000 euros, high blood pressure, type 2 diabetes and high cholesterol. Before the reform he paid 50% with no cap. Under the new law, once his band is updated, he will pay 45% with a cap of 61.75 euros a month.

• If in one month his medicines (other than reduced contribution ones) add up to a price of 150 euros, 45% would be 67.50 euros, but with the cap he will pay no more than 61.75 euros.
• In August he collects his medication at a pharmacy in the region where he spends the summer, and his cap does not apply there. He keeps the receipts and, when he returns, claims the refund on his health service's online portal.
• In December he checks in his region's health app that his new band now appears.

The figures are only an example to help you understand the calculation.

How can IMA Health help you?

The co-payment is set by national rules according to your situation and income. What can help is having your medication well organised so you neither run out nor pile up boxes. With IMA Health, a specialised pharmacy prepares your medication by the day and time of each dose, IMA coordinates with the pharmacy, delivers it to your home and provides personalised follow-up of your treatment.

Sources

• BOE: Royal Decree-Law 11/2026 of 12 May on user contributions to outpatient pharmaceutical services (in Spanish)
• BOE: Spanish medicines law, consolidated text (article 102, in Spanish)
• Community of Madrid: How much do I have to pay for my medicines? (in Spanish)
• Valencian Regional Government: State pharmaceutical contribution (in Spanish)

This article is for information only and does not replace advice from your doctor or pharmacist.