Every year, health insurance funds and associations of statutory health insurance physicians (KVen) conclude pharmaceutical agreements on the legal basis of Section 84 of the Social Code Book V. These include, among other things, a savings target with regard to pharmaceutical expenditure.

>> The savings are to be achieved, for example, through consistent prescription of low-cost generics and an increase in the prescription share of the lead substance(s) in the respective drug group. Since 2008, the drug group of nonsteroidal anti-inflammatory drugs (NSAIDs - anti-inflammatory drugs used for rheumatoid arthritis and other joint diseases and complaints) has also been included in the drug agreements of some KVs. While only diclofenac was defined as the lead substance in the last two years, ibuprofen was also included in the agreements for 2010.
When comparing drug prescriptions in the individual statutory health insurance regions, the significant east-west difference is particularly striking. While the two lead substances account for less than 77 percent of all daily NSAID doses in the eastern statutory health insurance regions (excluding the Berlin statutory health insurance region), the 11 western statutory health insurance regions all account for above the average of 83.5 percent (see Figure 1). Ibuprofen, in particular, is prescribed less frequently in the east: 33.5 percent compared to an average of 41 percent in the western statutory health insurance regions (basis: statutory health insurance prescriptions, first half of 2010, source: NVI-KV, INSIGHT Health).
Conversely, the East is clearly ahead in the prescription of coxibs, which are still fully patented: 14.2 percent compared to an average of 6 percent in the West. The first coxib was approved in Germany in 1999; for comparison: ibuprofen in 1969, diclofenac in 1975. The cost of coxibs per daily dose is almost 2.7 times the cost of the lead substances, diclofenac.
lofenac and ibuprofen (Source: Special analysis by INSIGHT Health based on statutory health insurance prescriptions in the first half of 2010). <

by: Christian Bensing and
Dr. André Kleinfeld*