Statutory health insurance expenditure on medicines declined in the first half of 2011
10.08.2011 16:31
Expenditure on pharmaceuticals and test diagnostics for the entire statutory health insurance market in the first half of 2011 amounted to almost 14.7 billion euros at pharmacy sales prices (AVP). The compulsory discounts to be paid by the pharmaceutical manufacturers as well as the discounts from the pharmacies to the GKV have already been deducted here. Compared to the first six months of the previous year, this means a decrease in expenses of 3.5%. Sales by packs increased by +0.8%. Excluding vaccines, which are recorded by the GKV via another cost center, the expenditure amounts to almost 14.3 billion euros with the same amount of decline and an increase in volume of 0.7%.
Compulsory discounts from service providers are approaching the 2 billion mark
The declining development is explained by increased manufacturer compulsory discounts (130a Para. 6 SGB V) as part of the AMNOG (Law for the Reorganization of the Pharmaceutical Market). In addition, there is a price moratorium set until 2013. The increased discounts from service providers have resulted in the resulting savings volume in the first half of 2011 already approaching the 2 billion mark (just under 1.9 billion euros).
Since 2011, wholesalers have also had to grant a discount of 0.85% on the selling price of the pharmaceutical company (ApU). This reduces the pharmacy purchase price (AEP) and consequently also the pharmacy sales price (AVP). The pharmacy discount that the offices have to grant statutory health insurance companies per pack for prescription medicines has been increased from 1.75 euros to 2.05 euros. This means that manufacturers, pharmacies and wholesalers alone shoulder a savings contribution of 11% of GKV pharmaceutical expenditure, with the lion's share going to the pharmaceutical industry.
Hardly any more, but larger packs were prescribed
Even though hardly any more medicine packages were sold over the pharmacy counter in the first half of 2011, there were at least +4.3% more large packs (N3) of prescription medicines prescribed. However, the prescription of medium (N2) and small packs (N1) decreased.
Among the 20 drug groups with the highest sales, patients received larger medication boxes, especially for treatments against chronic and/or widespread diseases. A striking example are remedies for stomach problems, which were prescribed in large packages by 20% more than in the previous year. For painkillers and antiepileptic drugs, the delivery increased by 10% each for the longest duration of therapy. Antidepressants increased by 7% in N3 boxes over the pharmacy counter and various therapeutic agents for the treatment of cardiovascular diseases between +2% (ACE inhibitors) and +10% (angiotensin II antagonists, A-II-A). With the exception of A-II-A and antiepileptic drugs, many of which still have patent protection, the majority of the other categories are generics. These in turn are often regulated by discount agreements.
The increased prescriptions of N3 packs could be explained by relatively cheaper co-payments for patients. In some cases, discount agreements may also encourage the sale of larger packs. This is evident in several drug groups, but there are also therapeutic categories with the opposite result.
Prescriptions for the very old are increasing
In view of the increasing life expectancy of people, the question of the associated higher need for treatment, including medication, is discussed in different ways. The so-called compression thesis states that with increasing age, morbidity and the need for treatment occur later thanks to medical and technical progress. In contrast, the central postulate of the so-called medicalization thesis is that a longer life also means a longer need for care.
There is empirical evidence for both theses. An exemplary analysis of the prescription situation in the first half of 2011 shows around +7% compared to very old patients aged 85 and over. Last year saw the largest increase in prescriptions. Of all the regulations, this group of people only accounts for a small proportion of just under 8%.
Figures from the Federal Statistical Office suggest that the increase in prescriptions for very old people can be seen as part of demographic change. According to this, the number of people over 85 in the German population increased from just over 1.5 billion people to just under 1.9 billion people between 2005 and 2009.
Data sources:
IMS PharmaScope® GKV: The data includes the pharmaceuticals dispensed by pharmacies for the statutory health insurance market.
IMS VIP®: Representative sample of practicing physicians from the most important specialist groups. Analyzes according to their diagnostic and therapeutic behavior. The data is collected at regional level and extrapolated to the level of the Federal Republic.
IMS Contract Monitor®: Coverage of over 99% of the statutory health insurance drug market (GKV prescriptions). Analytical differentiations are possible according to cash registers, markets, manufacturers and products.