Questions we hear from clinic billing staff who issue outside prescriptions: "What is the difference between Addition 1 and Addition 2?", "Why is no addition added to this prescription?", and "Do we need a posted notice or a notification?" The generic-name prescription addition is only a few points per prescription, but prescriptions are the document a clinic issues most often, so small rule gaps add up to lost revenue or audit risk.
This article uses the original text of the FY2026 medical fee schedule (MHLW public notice), the billing notice, and the facility-standard notice to explain the points, requirements, how to judge Addition 1 vs 2, and the posting rules.
Disclaimer: This article is general information based on public materials as of October 27, 2026. The MHLW notices are the authoritative source. For final billing decisions, always check the latest original text and the guidance of your regional bureau and review organization.
Overview
The generic-name prescription addition is set out in Note 6 to the prescription fee (item F400). When a clinic issues a prescription that states the generic (nonproprietary) names of drugs, it adds the following points, per prescription issued, to the base fee.
| Category | Points | Unit |
|---|---|---|
| Generic-name prescription addition 1 | 8 points | per prescription issued |
| Generic-name prescription addition 2 | 6 points | per prescription issued |
The base prescription fee is 20 points for category 1 (multiple psychotropic drugs), 32 points for category 2 (for example, seven or more oral drugs), and 60 points for category 3 (all other cases). The addition is added on top.
Conditions for billing
Three conditions must all be met.
- An outside (pharmacy) prescription is issued. The prescription fee is billed when a prescription is issued for dispensing at an insurance pharmacy; it does not apply when drugs are dispensed in-house (billing notice F400(2)).
- The facility standard is met (next section).
- The prescription is a generic-name prescription. For drugs that have generics, and biologics that have biosimilars, the prescription must give the generic name plus dosage form and strength instead of the NHI price-list product name (billing notice F400(12)).
In the notice's words, a generic-name prescription is one where the physician prescribes "without insisting on a specific brand, whether originator or generic, or originator biologic or biosimilar."
Facility standard: posted notice and website (no notification required)
The standard is in Section 36-4 of the facility-standard notice (Hoi-hatsu 0305 No. 8).
| Requirement | Content |
|---|---|
| Posted notice | Post in a place easily visible to patients an explanation of the purpose of generic-name prescribing, reflecting the drug supply situation and the fact that choosing a long-listed brand drug without medical necessity at the patient's request becomes a selected treatment (special charge) |
| Website | In principle, also publish the same content on the clinic's website. Clinics that do not manage their own website are exempt |
| Notification | Meeting the standard is sufficient; no notification to the regional bureau is required |
In practice, post the notice, and put the same content on your website if you have one; no filing is needed. Conversely, billing the addition without posting the notice means the facility standard is not met.
Drafting the notice
The notice should explain generic-name prescribing in light of supply conditions and the selected-treatment rule. The following is an example drafted by Pottech, not an official template.
Because the supply of some drugs is unstable, we may prescribe drugs by ingredient (generic) name rather than brand name, mainly for drugs that have generics, so that you can receive the medicine you need. You may choose any product with the same ingredient at your pharmacy. If you request a brand-name long-listed drug without medical necessity, a special charge as a selected treatment may apply. Please ask our staff if you have questions.
For the selected-treatment charge, see What Are Long-Listed Drugs?. If your notice states specific amounts or ratios, confirm them against the latest notice, since they can change with revisions.
Addition 1 vs Addition 2
The difference is how many of the drugs with generics on the prescription are written as generic names (billing notice F400(12)).
| Situation | Addition billed |
|---|---|
| All drugs with generics, and biologics with biosimilars, on the prescription are written as generic names | Addition 1 (8 points) |
| At least one drug on the prescription is written as a generic name | Addition 2 (6 points) |
| No drug is written as a generic name | Not billable |
Counting items
Items are counted by generic name. If the route of administration differs, the items are counted separately even when the generic name is the same (same notice). For example, an oral and a topical product of the same ingredient count as two items.
Examples
- A prescription has three drugs with generics, all written as generic names → Addition 1
- Three drugs with generics, one written by brand name → Addition 2
- One drug with generics, written by brand name → no addition
If a prescription contains no drug that has a generic, the notice's wording (the addition applies when drugs that have generics are prescribed by generic name) suggests the precondition is not met, but please also check how your review organization handles it.
Effect on the count of oral drug types
For the "seven or more oral drugs" test in prescription fee category 2, the notice says that when generic names are used, the price used for counting types is the lowest NHI price among the applicable drugs (F400(12)). Check that your EMR and billing software support this treatment.
Practical checklist
- The addition is applied only to outside prescriptions (not in-house dispensing)
- A notice explaining generic-name prescribing is posted where patients can see it
- If the clinic has a website, the same content is published there
- Drugs are written as "generic name + dosage form + strength"
- Addition 1 (all drugs with generics) vs Addition 2 (some) is determined automatically
- Oral and topical products of the same ingredient are counted as separate items
- The generic-name master is updated with price revisions and new generic listings
FAQ
Q. Is notification required?
A. No. The notice says meeting the standard is enough and no notification to the regional bureau is needed. The posted notice, and the website entry if you have a website, are still required.
Q. Does it apply to in-house dispensing?
A. No. It is an addition to the prescription fee, which applies when an outside prescription is issued.
Q. Does a generic-name prescription guarantee the pharmacy dispenses a generic?
A. A generic-name prescription means no brand is specified, and the pharmacy dispenses from products with the same ingredient. The choice depends on the patient's wishes, stock, and the selected-treatment rule. A clear posted notice reduces questions at your front desk.
Q. If some drugs are written by brand name, is the addition lost?
A. No. With at least one generic-name drug it is Addition 2; with all drugs having generics written as generic names it is Addition 1.
Summary
- The addition is Note 6 to the prescription fee: 8 points (Addition 1) or 6 points (Addition 2), per prescription issued
- It is billable when a clinic meeting the facility standard writes drugs with generics, or biologics with biosimilars, as generic names on an outside prescription
- All such drugs generic-named → Addition 1; at least one → Addition 2. Items are counted by generic name; a different route means a different item
- The standard is a posted notice (and, in principle, a website entry); no notification to the regional bureau is needed
- Billing without the notice does not meet the standard. Review your posting and EMR settings at introduction and once a year
For other prescription-related additions, see the specific disease prescription management addition article; for electronic prescriptions, the electronic prescription guide; for another standard that needs no notification, night/early morning addition requirements. Preventing missed billing is covered in the billing omission checklist, and the FY2026 revision overall in the FY2026 fee revision overview.
Pottech provides an AI EMR for clinics with billing-rule-aware receipt checking. If you need help with automatic judgment of prescription additions or settings after a revision, please feel free to contact us.
References
- MHLW, "Notice partially amending the method of calculating medical fees" (FY2026 MHLW Public Notice No. 69), Medical Fee Schedule F400 Prescription Fee, Note 6 https://www.mhlw.go.jp/content/12400000/001686842.pdf
- MHLW Health Insurance Bureau, "Points to note when implementing the partial amendment of the medical fee calculation method" (Hoi-hatsu 0305 No. 6, March 5, 2026), Annex 1, Part 5 Medication, Section 5 Prescription Fee, F400(2) and (12) https://www.mhlw.go.jp/content/12400000/001757385.pdf
- MHLW Health Insurance Bureau, "Handling of facility standards for specified treatment fees and notification procedures" (Hoi-hatsu 0305 No. 8, March 5, 2026, as corrected Oct. 7), Section 36-4 Generic-Name Prescription Addition https://www.mhlw.go.jp/content/12400000/001757367.pdf
- MHLW, FY2026 fee revision notices page https://www.mhlw.go.jp/stf/newpage_67729.html