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Buying Prescription Drugs in Rome: NRE Codes, Drug Tiers, and What You Actually Pay

Electronic prescriptions, drug tiers, Lazio co-pays, and generics — everything you need to pick up your medication in Rome without surprises.

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In a nutshell

To buy a prescription drug in Italy, all you need is the NRE code (a 15-digit number from the electronic prescription) and your Tessera Sanitaria (Italian health-insurance card). Your doctor rarely hands you a paper prescription anymore — they generate the code in a national IT system, and you receive it on a printout, by SMS, or directly in the Lazio Fascicolo Sanitario Elettronico (your regional digital health record). The price you pay depends on the drug's tier: Tier A drugs are covered by the SSN (Servizio Sanitario Nazionale — Italy's national health service), so you pay only the Lazio co-pay or nothing if you're exempt; Tier C drugs are fully out of pocket.

At a glance
Cost Tier A: Lazio co-pay only (~€1–2 per prescription). Tier C: full price. Tier H: free, hospital only.
Validity NRE prescription valid 30 days; chronic-disease prescription valid up to 12 months
Pharmacies in Rome 800+ pharmacies, all equipped to read NRE codes
Documents Tessera Sanitaria + NRE printout (+ exemption card if applicable)

How the electronic prescription works

Since 2014–2015, the old pink paper prescription has been almost entirely replaced. Your doctor generates a dematerialised prescription in the TS (Tessera Sanitaria) system run by the Ministry of Economy. The result is a 15-digit code: the NRE.

You can find your NRE in three places:

At the pharmacy, show your Tessera Sanitaria and the printout — or simply read the NRE code aloud. The pharmacist pulls up the prescription, records the dispensation, and hands you the medication. You can use any pharmacy in Italy, not just in Rome or Lazio.

Drug tiers: what you actually pay

Tier A: essential drugs and chronic-disease medications. The SSN reimburses these. You pay only the Lazio co-pay — or nothing if you qualify for an exemption. The current Lazio co-pay is roughly €1 per prescription plus €1 per pack (maximum €2 per prescription). If you insist on the branded version instead of the generic equivalent, you also pay the price difference above the AIFA (Italy's drug-regulatory agency) reimbursement ceiling.

Tier C: non-essential drugs — many painkillers, antacids, some antihistamines, contraceptives. These are entirely out of pocket, even with a prescription and even if you hold an exemption. The receipt is deductible at 19% on your Italian income tax return if you provide your Codice Fiscale (Italian tax ID — your personal 16-character code, used for almost everything) at the register.

Tier H: hospital-only use. Not sold in pharmacies.

Generics vs brand-name: clinically identical

When a doctor prescribes a drug by its active ingredient (the INN — International Non-proprietary Name), the pharmacist will offer both the original branded drug and one or more generic equivalents. Under Italian law (L. 405/2001) generics are identical: same molecule, same dose, same bioavailability certified by AIFA.

The SSN reimburses up to the AIFA reference price. If you pick the more expensive brand, you cover the difference. If you go generic, you often pay nothing extra. There is no clinical difference between the two — choosing the generic saves you money without giving up anything.

Step-by-step: buying your medication

Tier A drug with an NRE prescription (e.g., a blood-pressure medication, an antibiotic):

  1. Your doctor issues the electronic prescription; you receive the NRE printout.
  2. Go to any pharmacy within 30 days (or within 12 months for an extended chronic-disease prescription).
  3. Hand over the printout and your Tessera Sanitaria; show your exemption card if you have one.
  4. The pharmacist records the dispensation in the national system.
  5. Pay the Lazio co-pay (or nothing if exempt), plus any brand-vs-generic price difference if you declined the generic.
  6. Collect your medication and receipt.

Tier C drug with a white prescription: Take the doctor's signed paper prescription to the pharmacy, pay the full price, and ask for a receipt with your Codice Fiscale so you can claim the 19% tax deduction.

Lost your printout? No problem — the prescription lives in the national TS system. Log into your FSE Lazio, find the NRE, and read it to the pharmacist. In some cases, the pharmacist can look it up using only your Codice Fiscale.

Exemptions: who pays nothing

The main categories exempt from the Lazio pharmaceutical co-pay:

  • E01–E04: low-income households, unemployed people, recipients of minimum or social pension.
  • Disease code: diabetes, epilepsy, cancer, HIV, and many other chronic conditions (each has a specific AIFA code).
  • Disability: civil, occupational, war-related, or service-related.
  • Pregnancy (codes M00–M99): for drugs and tests related to pregnancy.
  • Organ, blood, or bone-marrow donors.

To apply for or renew an exemption, visit the URP (public-relations desk) at your ASL (Azienda Sanitaria Locale — your local public-health authority), or do it online at salutelazio.it if you have SPID (Italy's digital identity for accessing online public services).

Prescription types you should know

  • RR (Repeatable): you can fill it up to 10 times over 6 months. Used for many chronic medications.
  • RNR (Non-Repeatable): single dispensation only (antibiotics, some psychiatric drugs).
  • Extended NRE chronic prescription: for conditions registered under a therapeutic plan. Valid 12 months, up to 6 fills. The pharmacy automatically deducts from the remaining allowance each visit.
  • Controlled-substance prescription (Schedule II–III–IV): for opioids and psychotropics. Requires a valid photo ID from the person collecting the drug, and the dispensation is logged in the pharmacy's controlled-substances register.

Mistakes to avoid

  1. Don't buy drugs from unauthorised websites. In Italy, online pharmacy sales are legal only for pharmacies registered with the Ministry of Health, identifiable by the common European bar logo (blue/white flag) on their homepage. Every other site is illegal and the drugs may be counterfeit. Check the official list.
  2. Don't ask for antibiotics without a prescription. It's illegal and fuels antibiotic resistance — a serious global health problem. No responsible pharmacist can or will comply.
  3. Don't send someone to collect prescription drugs on your behalf without a written proxy. If you can't go yourself, give the person collecting: your ID, their ID, and a simple written authorisation. For controlled substances the rules are stricter.

Special cases

You're pregnant: you're entitled to the M00–M99 exemption for many pregnancy-related drugs and tests. The code is applied directly on the prescription by your doctor or gynaecologist.

You need a drug no longer sold in Italy: the pharmacist can check wholesale suppliers or initiate the AIFA import procedure from abroad (7–30 days). Alternatively, they'll refer you to the hospital pharmacy service at the nearest public hospital.

You're an EU visitor in Rome with a EHIC (European Health Insurance Card): you can buy drugs at an Italian pharmacy like a resident, paying the applicable Lazio co-pay. For prescriptions issued in your home country: using them directly is complicated in practice — it's easier to ask an Italian doctor to reissue an Italian prescription.

You need medical devices (needles, glucose test strips, infusion sets): available at pharmacies. Some are reimbursable by the SSN under a therapeutic plan (e.g., for diabetes). Ask your GP (medico di base) to include them in your plan.

Official sources

Legal references: DLgs 219/2006, DL 70/2011 art. 11, DM 2/11/2011, L. 405/2001, L. 178/2020, DL 41/2021, DGR Lazio 437/2019 e 14/2024, DPR 309/1990, L. 38/2010.

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