Medical Prescriptions in Italy: Red Recipe, White Recipe, and the NRE Code Explained
The old red prescription slip is gone — today it's a 15-digit NRE code on plain white paper. Here's what that means, who issues what, and how to avoid losing your prescription.
In a nutshell
The "impegnativa" (Italian doctor's prescription from the national health service) comes in two flavours: the red prescription (now almost always electronic) for reimbursed medicines and specialist NHS visits, and the white prescription for everything you pay out of pocket. Since 2020, the red prescription is no longer a red slip of paper — it's a 15-digit code called the NRE, printed on a plain white reminder sheet.
At a glance
| Cost | Free to issue (SSN — Servizio Sanitario Nazionale, Italy's national health service). Ticket (co-pay) on the prescription itself: varies or €0 if you're exempt. |
| Turnaround | Immediate — issued at your appointment or via phone/WhatsApp with your GP. |
| Validity | Medicines: 30 days · Specialist visits/tests (SSN): 1 year · Repeatable white prescription: 6 months |
| Where to find your prescriptions | FSE Lazio (Lazio's digital health record) — log in with SPID (Italy's digital identity for accessing online public services) or CIE (Italian electronic ID card) |
Red vs white prescription: the key differences
The red prescription (SSN) gives you access to reimbursed medicines (drug classes A and B) and specialist visits or diagnostic tests, either free or at a subsidised co-pay. Your GP, paediatrician, or any SSN specialist issues it for free through the national Sistema Tessera Sanitaria (TS) platform — the infrastructure behind the Tessera Sanitaria (Italian health-insurance card). The result is an NRE — a 15-character code — plus a plain white reminder slip with a barcode. Take the slip (or just the NRE) to a pharmacy or to the ReCUP booking service to schedule your visit.
The white prescription is private: you foot the entire bill. It's used for class-C medicines — most anti-inflammatories, oral contraceptives, many psychiatric drugs — and for any service delivered in a private or intramoenia (hospital-run private practice) setting. Any licensed doctor can issue it, including private specialists.
A simple rule of thumb: if the prescription comes from your MMG (medico di medicina generale — your NHS GP) or from an SSN specialist during a public visit, it will almost always be a red prescription. If it comes from a private doctor or a paid consultation, expect a white one.
Who issues prescriptions
Your GP (MMG) and paediatrician are the primary points of contact: they issue red prescriptions for medicines and referrals (impegnative) for specialist visits. SSN specialists in outpatient clinics or hospitals do the same for follow-up tests after a first consultation. Out-of-hours medical services (116117 — Continuità Assistenziale) can issue limited red prescriptions for urgent needs outside normal hours, valid for 48 hours.
Only authorised specialists can prescribe so-called "restricted" medicines (oncology drugs, biologics, antiretrovirals): your GP can prescribe them only when they hold a written piano terapeutico (treatment plan) issued by the specialist.
Opioids and strong narcotics (morphine, methadone) require a special paper prescription booklet — the ministerial carbon-copy pad — and cannot be issued electronically.
How to get and use a prescription
Chronic medication — renewing a repeat prescription. No need to go in person. Call, send a WhatsApp, or email your GP's practice with the medicine name and dose. The doctor issues the prescription in the TS system and either sends you the NRE by SMS or leaves the reminder slip for you to pick up. Take your Tessera Sanitaria and the NRE to any pharmacy; the pharmacist pulls up the prescription directly from the system. Validity: 30 days from issue. For chronic conditions, a single prescription can cover 3–6 months of therapy.
Specialist referral. Visit your GP and explain your symptoms. If they consider a specialist visit warranted, they issue an electronic referral with a priority code (U = urgent, B = short, D = deferrable, P = planned). You receive the NRE reminder slip and book through ReCUP (call 06 9939 or use the SaluteLazio app).
White prescription. The doctor gives you either a digital prescription (with its own NRE) or a paper one. Go to the pharmacy or the clinic and pay the full amount. Keep the scontrino parlante (itemised receipt showing your Codice Fiscale — Italian tax ID — and the drug code): you can claim a 19% tax deduction on your annual return, above a €129.11 threshold.
Lost the reminder slip? No problem. Log into the Fascicolo Sanitario Elettronico Lazio (Lazio's electronic health record) with SPID or CIE, open the "Ricette" or "Prescrizioni" section, and all your NREs are there. The prescription lives in the TS system; the paper slip is just your personal copy.
Drug classes: A, B, and C
| Class | What's in it | Who pays |
|---|---|---|
| A | Essential medicines (e.g. antihypertensives, common antibiotics) | SSN (free or with a co-pay capped at ~€4 per pack in Lazio) |
| B | Essential medicines with partial co-pay | Mainly paid by SSN; some categories (elderly, exempt patients) pay nothing |
| C | Non-reimbursed medicines (e.g. most anti-inflammatories, oral contraceptives) | Full cost to the patient |
When the pharmacist suggests a generic (same active ingredient, lower price) you can accept it or ask for the brand name and pay the price difference yourself. If the doctor has written "non sostituibile" (not substitutable) on the prescription, no swap is allowed.
Mistakes to avoid
- Confusing the reminder slip with the actual prescription. The white sheet your doctor hands you is not the prescription — it's a paper reference. The real prescription is in the TS system, identified by the NRE. If you lose the slip, retrieve the NRE on FSE Lazio; you don't need to go back to the doctor.
- Buying medicines from unauthorised websites. Only pharmacies displaying the official AIFA green logo on a white background are licensed to sell medicines online in Italy. Foreign "low-price" sites frequently sell counterfeit products.
- Thinking you have to pay to get an SSN prescription. Issuing a prescription is always free. You only pay the co-pay on the medicine or visit (if you're not exempt). If anyone charges you to write a prescription, it's a scam.
Special cases
Chronic patients with a treatment plan. The doctor can issue a single prescription covering 3–6 months of continuous therapy — useful for diabetes, hypertension, oncology, and depression.
Medicines with an AIFA Nota. Certain drugs are only reimbursed under specific clinical conditions (e.g. statins above certain cholesterol levels). The doctor must indicate the Nota number on the prescription; without it, the pharmacist cannot dispense the medicine at the SSN's expense.
Expired prescription. It cannot be extended. Go back to your doctor for a new one — the pharmacist has no discretion here.
Foreigners with an STP or ENI card. STP (Straniero Temporaneamente Presente — a temporary code for undocumented migrants) and ENI (Europeo Non Iscritto — for unregistered EU citizens) holders can receive prescriptions from dedicated centres such as SaMiFo at Via Luzzatti 8 — ASL Roma 1 (Azienda Sanitaria Locale — your local public-health authority) — or Caritas clinics. Essential care is free even without a residence permit.
Medicines while travelling abroad. If you take chronic medication, ask your GP for a paper prescription in English (sometimes called a "Schengen prescription") to use at foreign pharmacies.
Picking up someone else's prescription. You can collect for a family member by presenting their Tessera Sanitaria. For narcotics, you'll also need a written authorisation from the patient.
Official sources
- Ministry of Health — Electronic prescription
- Sistema TS — national portal
- FSE Lazio — Fascicolo Sanitario Elettronico
- Salute Lazio
- AIFA — Italian Medicines Agency
- Federfarma — Contracted pharmacies
- Ordine Farmacisti Roma
Legal references: Legge 23/12/1978 n. 833, DPR 09/10/1990 n. 309, DM 02/11/2011, DPCM 14/11/2015, DL 19/05/2020 n. 34 art. 38, DM Salute 25/03/2020, D.Lgs. 219/2006, DGR Lazio 1056/2022.