>> These “autonomous” cost-reducing effects of drug competition are complemented and reinforced by two health policy instruments: fixed amounts and discount contracts. In the case of fixed amounts, the health insurance companies (actually the National Association of Statutory Health Insurance Funds) calculate a “fixed” amount in the lower third of the price spectrum for a group of therapeutically comparable drugs (the group is determined by the Federal Joint Committee) according to a complex but clearly defined and verifiable procedure, up to at which the statutory health insurance companies reimburse the group's medication; If a product is more expensive than the fixed amount, the patient must pay the difference himself. In the case of discount agreements, the health insurance companies publish tenders for substances for which there are several therapeutically comparable drugs on the market, in which the drug manufacturers in question can participate with discount offers for the price of their respective product. The (one to three) provider(s) with the greatest potential savings for the fund will receive the (or one) contract. In return for the discount granted, the tender winners become the exclusive suppliers of prescriptions for the insured persons of the respective health insurance fund for a limited time (usually two years).
From an economic point of view, the fixed amounts, with estimated annual savings of seven billion euros for the statutory health insurance companies, are significantly more effective than the discount agreements, whose annual cost reduction contribution is estimated at a good three billion euros. In therapeutic terms, however, the interventions through discount contracts are much stronger. Fixed amounts have no influence on the selection of the specific drug - it is prescribed by the doctor and dispensed by the pharmacist - but only on the price that the health insurance companies reimburse. With discount agreements, on the other hand, the pharmacist must normally supply the product from the manufacturer with which the patient's health insurance company currently has a discount agreement, regardless of which specific medication the doctor has prescribed. If the prescribed medication and the discount medication do not match, the pharmacist will substitute the former for the latter. Patients who have to take certain medications long-term can be affected by a new substitution every two years, or even with every new prescription in the case of so-called open-house contracts.
Since generics have existed, there has also been a discussion about whether the original preparation and the (usually several) generics are really therapeutically equivalent, i.e. whether effectiveness and tolerability remain the same when switching from one to another. In fact, different products, even if they are the same in terms of the type and amount of active ingredients, can differ in terms of their galenics, i.e. their excipients and... <<