Can we refuse to replace a drug with a generic or hybrid or biosimilar?

Verified 14 September 2026 - Public Service / (Prime Minister)

Replacement of a reference drug may be done with a generic or hybrid or biosimilar.

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Replacement with a generic

Yes. It is possible to refuse the replacement of a drug with a generic drug. A generic drug is made from the same molecule as a reference drug. It costs less.

However, your refusal has consequences on the third-party payee's profit, the refund period and the level of refund.

Third party paying

You will not benefit in principle from third-party payer in pharmacies (waiver of advance fees).

However, you can benefit from this advance fee waiver in some cases. This is the case, in particular, where:

  • Your doctor put a statement " non-substitutable and the medical reason for refusing the substitution, using one of the authorized acronyms (MTE, EFG or CIF)
  • The price of the generic drug is greater than or equal to the price of the original drug.

Please note

Just like with your doctor, you can ask your pharmacist questions or talk to him about a problem with the generic medicine (for example: an unappreciated taste or a less convenient tablet form).

Reimbursement period

The pharmacist shall establish a care sheet paper for the medicine in question, which you send, together with a duplicate of the prescription, to your health insurance fund for reimbursement.

You must first advance the costs for the entire prescription concerned and then be reimbursed by your health insurance organization.

The the repayment period is therefore longer due to the time it takes to process your treatment sheet.

Level of reimbursement

You will be refunded on the basis of flat rate of liability (TFR). This tariff sets an identical reimbursement amount for the original drug and for generic drugs.

If you want a brand name drug with a higher price, the additional cost is at your expense.

Example :

A doctor prescribes you a brand-name drug that costs €20 and which has a TFR of €18.

If you refuse to have a generic drug dispensed by the pharmacist, you pay for the brand-name drug €20, or €2 more expensive than the generic. You are then reimbursed on the basis of €18 instead of €20.In addition, you must advance the money to the pharmacist because you do not benefit from the advance fee (third-party payment).

However, if you accept a generic drug, it does not change anything for you, it will be reimbursed as usual.

Replacement with a hybrid or biosimilar drug

The pharmacist can offer you a medicine hybrid or biosimilar in place of the reference medicinal product.

If you refuse this proposal, you will not benefit from third-party payer in pharmacies (waiver of advance fees).

You pay the full amount of the medicine. You are then reimbursed by the Health Insurance at fixed rate.

However, the paying third party cannot you have been refused in 2 cases:

  • Your doctor rules out replacing the reference medicine because of your medical condition. It states this exclusion on your prescription
  • The brand name drug has a price less than or equal to the price of the hybrid or biosimilar drug.

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