Fibromyalgia has lost its “invisibility.” As of September 30, 2026, it has been recognized among chronic and disabling conditions within the new LEA (Livelli Essenziali di Assistenza, Essential Levels of Care). This marks a very important milestone: for patients who had waited for this for a long time, for patient associations such as AISF (Associazione Italiana Sindrome Fibromialgica) ODV and CFU (Associazione Fibromialgici Italia) that have undertaken significant and lengthy battles to secure guaranteed access to care, and for clinicians like the Collegio Reumatologi Italiani (CReI), whose satisfaction is, however, only partial.
In fact, the LEA at present are guaranteed only for patients with severe forms of fibromyalgia. The current push and work of associations, clinicians and experts is now to aim for the extension of the LEA, and the related opportunities, to all patients, with none excluded. The hopes and expectations of every person living with the disease and their families must not be disappointed.
The Numbers and Implications
Fibromyalgia is a complex, disabling, and serious condition that profoundly affects quality of life and work capacity. It concerns roughly the 2-4% of the Italian population, with a predominance of women. It is characterized by widespread musculoskeletal pain, fatigue, sleep disturbances, cognitive difficulties, and mood alterations as among the main symptoms.
Diagnosis today is observational, based on clinical assessments that must also exclude conditions that can mimic fibromyalgia, such as hypothyroidism, due to the absence of specific tests. It requires a multidisciplinary approach that combines medications, lifestyle adjustments (from diet to an adapted physical activity program), and psychological support.
Inclusion in the LEA, what changes and who is entitled
The access modalities to the LEA are defined by the Dpcm of August 7, 2026, published in the Official Journal on September 30, 2026, with entry into force on October 30, 2026, and confer the right to exemption from the co-pay for very severe forms of the disease, defined by very specific criteria.
Among these, a FiQR score above 82 on the Fibromyalgia Impact Questionnaire Revised (FiQR), which measures the level of disability on a 0-100 scale across several parameters such as pain, fatigue, sleep quality, daily functional capacity, and emotional impact. According to experts, only about 16% of fibromyalgia patients would meet these criteria, leaving out a large portion of the population that is still significantly affected.
Patients holding exemption code 068 will have free access to three specific services: a yearly check-up to monitor the disease and prevent complications; group motor rehabilitation, limited to groups of up to six patients with similar pathology, comprising a cycle of 10 sessions of 60 minutes each, every 12 months; and a psychiatric consultation every 12 months, eligible only in the presence of comorbid psychiatric conditions. Any other services, such as radiological tests, laboratory work, or other examinations, are not covered by the LEA under this program.
The exemption lasts a minimum of two years, under current regulations, requiring patients to undergo regular checks to confirm the persistence of the eligibility criteria for renewal of the exemption for another two years. The national decree essentially sets the minimum exemption criteria, defined by the Ministry of Health, also to contain public spending. However, it does not exclude that individual Regions may autonomously apply an expansion to include a larger number of patients with the disease. It is not excluded, finally, that the LEA could open the door to civil disability benefits for fibromyalgia as well.
The Medical Perspective
The Italian Society of Rheumatology (SIR) recommends approaching this transitional phase with great caution, especially since clearer operational modalities are awaited to better define access to pathways and services. In this initial phase, therefore, there are no changes to clinical practice as it has been conducted to date.
That is, a patient with fibromyalgia or with a suspected diagnosis must book through the CUP (Centro Unico di Prenotazione) of a public facility, with a medical prescription, for a rheumatology consultation during which the necessary evaluations will be carried out. The instructions that will be provided in the future may be implemented differently from region to region.
The rheumatologist remains central in the care pathway, responsible for taking charge of the patient and coordinating the multidisciplinary team, potentially envisaging dedicated pathways—so far still to be built—up to a PDTA (Percorso Diagnostico Terapeutico Assistenziale) applicable to this exemption, in synergy with rheumatologists in the territory. Follow-up and regular monitoring at II and II-level centers remain essential.
In the Lombardy region, a dedicated app has been created – FIBRO-NET Care – which also enables clinimetric assessments (FiQR, WPI (Widespread Pain Index), the Pain Diffusion Index, and SS (Symptom Severity Scale)). All of these scores allow tracking the disease’s evolution over time, including the response to therapies.
In the Liguria region, on the other hand, the disease diagnosis is made by the rheumatologist, with the possibility since 2020 to include certain treatments in an annual therapeutic plan following a certified fibromyalgia diagnosis. While renewal of the plan can also be managed by the neurologist and the pain therapist. It is also important to have a physiatric assessment, which may involve the occupational physician for patients who are still professionally active. A crucial role is played by the patient, who must be proactive—for example, by requesting the FiQR if it is not performed, or information about new drugs, and by taking an active role in their own therapy.
INPS Tables
They are expected to be updated, most likely by the end of 2028, with the changes beginning 12 to 24 months after the publication of the Dpcm. INPS prioritizes functional deficits over symptoms when evaluating claims. Therefore, in the documentation submitted to the Agency, it is advisable to highlight the functional, motor, or other deficits that have developed over time. It is also worth noting that the exemption is to be provided by the National Health Service, hence issued by a physician from a public authority. Telemedicine, already used in the Lombardy region, could be highly valuable for re-evaluating fibromyalgia, such as adjusting a therapy, and could be expanded to additional monitoring between annual checks.
Future Actions
The recognition within the LEA marks an important starting point. The commitment of patient associations, clinicians, scientific societies and professional bodies is to work in synergy and push for a national fibromyalgia law. This would enable more uniform and structured patient management across the country, with appropriate diagnostic-therapeutic-care pathways, recognition of social and work-related needs, equitable access to care, and real protection for people living with fibromyalgia.
Abbonati a Karla Miller
