Politicians attempted to limit increasing expenditure on prescription drugs in statutory health insurance (GKV) with a series of regulatory measures [1]. In addition to the aut-idem regulation, fixed amounts, price moratoria and compulsory discounts, this also includes import promotion according to Section 129 SGB V. Medicines that are available on the market at lower prices in other European countries are bought up commercially by importers and distributed to patients via pharmacies in the country. In addition, there is an import quota, which determines the percentage of imported medicines to be sold by the pharmacist in the pharmaceutical sales [2]. Conceptually, a distinction can be made between parallel-imported and re-imported medicines. The majority of imported goods on the German market are parallel imports. These are medicines that are produced abroad by multinational pharmaceutical companies and imported into Germany by both the manufacturer and the importer [3]. Reimports, on the other hand, are medicines that were produced in Germany and exported to other countries. Re-importers buy them there at a cheaper price and bring them back to Germany [4]. Since new health policy instruments with the aim of limiting expenditure usually do not replace existing ones, but rather expand them, this add-on regulation in the statutory health insurance market leads to an increasingly complex regulatory framework with unclear impact relationships [5-6]. What also seems important from the perspective of health services research is that even unintended negative effects can limit the acceptance of regulatory instruments in practice. The aim of the present study was therefore to qualitatively record the effects of import promotion perceived by the actors.

Read more