How to Get an ADHD Medication Report for SGK Coverage

You got the prescription, went to the pharmacy and heard a figure at the counter that you were not expecting.

This is what many people who start ADHD medication go through in the first month. The reason is simple and lies in a distinction no one told you about beforehand: the prescription makes it possible for the medication to be prescribed, the report makes it possible for the cost to be covered.

This article explains how that report is obtained. The rules are updated; take the framework here as information, and confirm what is binding with your doctor and your pharmacy.

Two separate documents

All of the confusion comes from mixing these two up.

The red prescription (the controlled-substance prescription) governs the prescribing of a controlled medication. Who can prescribe it, how many boxes can be prescribed and within what time it must be used are fixed. I explained the details in the article on the red prescription.

The medication use report makes it possible for the Social Security Institution (SGK) to cover the cost of that medication. In everyday speech it is also called a medication exemption report or a board report.

If you have a prescription but no report, you get the medication and you pay for it yourself. If you have a report but no prescription, you cannot get the medication at all.

Who issues the report

A psychiatry specialist for adults, a child and adolescent psychiatry specialist for children and adolescents.

A family doctor does not issue reports for ADHD medication. Even if another doctor made the diagnosis, you need to go to a specialist for the report. I explained the diagnosis process itself in the article on how adult ADHD is diagnosed.

When the report is issued it is entered into e-Nabız. So even if you lose the paper, it stays in the system; the pharmacy can see it from there.

How long it lasts

I am not writing a fixed figure here, and let me write the reason too, because most of the figures written on the internet are not current.

The duration of the report depends on two things: what the doctor stated on the report and the provisions of the Health Implementation Communique. The communique is updated regularly; a period that was right a year ago can be wrong today.

The only thing that is binding is the end date written on the report.

The moment you see that date there is one thing you need to do: write it in the calendar. Not the end date itself, but one month before it. Because finding an appointment takes time, and on the day the report ends the medication becomes paid.

What happens when the report ends

When the report period runs out the medication does not disappear; its cost passes to you.

This is the quietest way for treatment to be interrupted. No one tells you. You go to the pharmacy, you hear the figure and you decide not to buy the medication that month. The next month too.

Expecting flawless paperwork follow-up from someone who struggles with attention and organization is the most ironic side of this system. I wrote about this burden separately in the article on paperwork and bureaucracy.

What to do in practice

Get the report before the prescription. The two can be settled in the same appointment, but the order matters: a prescription without a report is a prescription you pay for yourself.

Write the end date in two places. A reminder in the calendar, and in the single note on your phone. Set the reminder not for the end date but for one month earlier.

Carry the report and the prescription together. The pharmacy may want to see both; have your ID with you too.

If the dose changes, ask your doctor. A change of dose may require the report to be updated. I explained why dose adjustment goes on in the article on dose increases.

If you change hospitals, know where the report is. It is visible through e-Nabız; tell your new doctor that they can reach it from there.

A separate world for children

Under 18 the report side runs differently. There is a separate assessment there called ÇÖZGER, and its logic is completely different from the adult report. I explained it separately in the ÇÖZGER article.

The school side is a completely different process: the RAM report (RAM is the Guidance and Research Center) and the BEP (the Individualized Education Program). None of these replaces another, and this is where parents lose the most time.

What I take from it

The most irritating side of this system is that no step is written in a single place. You learn who will write the prescription from one place, how long the report will last from another and what the pharmacy will ask for from a third.

What I took from writing this article that is useful is to turn this into a one-time job: a single note. The name of the doctor who wrote the report, the report's end date, the date of the last prescription, the name of the pharmacy. Updating these four lines after each check-up is enough.

The existence of this note does not improve the treatment. It only stops the treatment from being cut off on its own, and in this picture the two are almost the same thing.