›› CHIFA card and the third-party payment system

Extension of the Use of the Chifa Card and Access to the Third-Party Payment System for Pharmaceutical Products Nationwide

Starting from February 3, 2013, the CNAS (National Social Insurance Fund) launched the process of inter-wilaya expansion of the third-party payment system for pharmaceutical products across the entire national territory.

A socially insured person holding a Chifa card benefits from the third-party payment system for pharmaceutical products by visiting any contracted pharmacy in any wilaya (province), regardless of which local CNAS agency they belong to. However, the insured person continues to be attached to their original payment center.

Beneficiaries :

All socially insured persons, holders of the Chifa card, and their dependents, benefit from the third-party payment system for pharmaceutical products at the contracted pharmacy of their choice throughout the national territory, regardless of their CNAS affiliation agency.

Prescriptions Covered :

1) Case of socially insured persons or their dependents with chronic illnesses :

Covered under the national expansion of the third-party payment system for pharmaceutical products:

• • Any prescription including a specific treatment prescribed for a maximum period of three (3) months ;
  • Any prescription outside of the specific treatment, regardless of its amount or number.
  • Any medication subject to special reimbursement conditions or affected by the reference pricing system, when it is part of a specific treatment listed on the Chifa card, for which prior approval from the CNAS medical advisor has already been granted

Any medication subject to special reimbursement conditions or affected by the reference pricing system, when it is part of a specific treatment listed on the Chifa card, for which prior approval from the CNAS medical advisor has already been granted.

If this medication is not listed on the Chifa card, the pharmacist invites the insured person to visit the medical control office, either at the nearest payment center or at their affiliated center, for prior authorization.

2) Case of socially insured persons aged 75 or older:

Covered under the national expansion of the third-party payment system for pharmaceutical products:
All prescriptions, regardless of the type of treatment, amount, or number.

If a prescription includes a medication subject to special reimbursement conditions or to reference pricing rules, the pharmacist dispenses the medication without prior CNAS approval (no prior control).
However, such prescriptions will be subject to post-payment medical review (after the pharmacist has been reimbursed).

3) Case of socially insured persons receiving social security benefits

(e.g., retirees, disabled persons, pensioners with a disability rate ≥ 50%, etc.):

Covered under the national expansion of the third-party payment system for pharmaceutical products:
All prescriptions, regardless of their amount or number.

If a medication is subject to special reimbursement conditions or reference pricing, the pharmacist invites the insured person to visit the medical control office, either at the nearest payment center or at their affiliated center, for prior authorization.

4) Case of active insured persons or those in special categories:

Covered under the national expansion of the third-party payment system for pharmaceutical products:

• Any prescription with an amount less than or equal to 5,000 DZD.

• The first two prescriptions for the same beneficiary within a three (3) month period.

If the prescription amount exceeds 5,000 DZD or it is the third prescription within three (3) months for the same beneficiary, the insured person must pay the pharmacist directly.
This amount will later be reimbursed by their payment center according to the usual procedure.

Practical Arrangements

Updating the Chifa Card

If the insured person’s Chifa card is not up to date regarding entitlement status or there has been a change in dependents, they must visit their payment center with the necessary supporting documents so that their rights (and those of their dependents) can be updated.

Dispensing Medications by the Pharmacist

Once the pharmacist inserts the Chifa card into the reader, the system identifies the beneficiary and indicates whether the prescription is eligible for third-party payment.

If eligible:

• The pharmacist enters the medications,

• Validates the invoice, and

• Dispenses the medications.

The pharmacist removes the drug labels (vignettes) and attaches them to the prescription.
The Chifa card is returned to the insured person, who must pay the 20% co-payment when coverage is at 80%.

If the insured person is a member of a contracted mutual insurance fund, they are exempt from paying this 20% (the co-payment), and owe nothing to the pharmacist.

The insured person must, however, pay for:

• Non-reimbursable medications, and

• Any difference between the retail price and the reference tariff, if applicable.

If the prescription includes a medication that can only be reimbursed under certain therapeutic conditions, or one affected by reference pricing rules, the pharmacist invites the insured person to visit the medical control office, either at the nearest payment center or at their affiliated center, for prior control.

Key Points to Remember

• Each pharmacy remains attached to its original payment center.

• Prior control is maintained only for medications requiring special reimbursement conditions or subject to reference pricing rules.

• The insured person may choose to pay the pharmacist upfront for a medication requiring special authorization and later request reimbursement (subject to CNAS medical approval).

• The insured person can go to any medical control office—either at the nearest payment center or their affiliated center—for prior control.

For any further information, the insured person may contact their affiliated payment center.

“CHIFA-OFFICINE” Software

The system is deployed through the installation of the CHIFA-OFFICINE software in contracted pharmacies.
This software allows pharmacists to:

• Read the Chifa card

• Enter medications

• Update the Chifa card

• Digitally sign invoices (with a token)

• Extract electronic invoice summaries

• Load new software versions

• Load the blacklist of expired cards