More money for less care
07.11.2023 11:54
Net spending on medicines at the expense of statutory health insurance reached a new record high of 52.9 billion euros in 2022. In a ten-year comparison, net costs have increased by 88.0 percent. The costs for patent-protected medicines have even doubled during this period: they were 27.8 billion euros in 2022, while in 2013 they were 13.9 billion euros. This means that more than every second euro in pharmaceutical expenditure in 2022 was for patent-protected medicines (52.6 percent).
For comparison: Germany's economic power - measured in terms of gross domestic product - rose by just under 38 percent in the same period. An evaluation of the prescribed daily doses shows that the patented medicines only cover 6.8 percent of the supply. In 2013 this value was 12.2 percent; it has fallen by more than 30 percent in the past ten years.
“The long-standing trend that patented medicines cost more and more, but at the same time contribute less and less to supply, continued last year,” says Helmut Schröder, Managing Director of the AOK Scientific Institute (WIdO). “The legal regulations for early benefit assessment and subsequent price negotiations introduced in 2011 with the Pharmaceutical Market Reorganization Act clearly have only a limited influence on the pricing of patented drug manufacturers.”
Doubling the cost of patent-protected drugs
While the net costs of medicines have increased by 88.0 percent in the last ten years, the number of prescriptions has only increased by 12.6 percent - with an increase in the number of people insured by statutory health insurance by 5.5 percent. The reasons for the increase in pharmaceutical expenditure are, in addition to a general increase in the quantity of prescriptions, also the annually increasing prices for pharmaceutical packaging. In 2022, the value per prescription increased again by 0.2 percent, and the number of prescriptions rose by 4.9 percent compared to the previous year. In December 2022, the average price for prescription finished medicines was 1,763.32 euros, compared to 1,260.99 euros in the same month last year (+ 39.8 percent). In December 2022, patent-protected medicines even had an average price of 20,631.41 euros per pack. This value is 44.4 percent higher than the price for patent-protected drugs in the same month last year (average 14,289.81 euros). For this reason, too, every second euro of drug costs in 2022 was spent on these patent-protected drugs (52.6 percent) - with only a low prescription coverage of 6.8 percent (measured in terms of prescribed daily doses). “Despite legal measures such as the Statutory Health Insurance Financial Stabilization Act, no trend reversal is expected in the current year. A further increase in statutory health insurance expenditure is to be expected,” predicts Helmut Schröder.
Since 2011, the Medicines Market Reorganization Act (AMNOG) has ensured that new patent-protected medicines without additional benefits for patients are recognized. “Because new is not always innovative,” emphasizes Helmut Schröder. This was shown by the results of the AMNOG procedure up to 2021: In 61.5 percent of the targeted patient groups, the AMNOG evaluation procedure could not determine any additional benefit compared to the existing comparative therapy. Relatively high costs are incurred by new drugs that have no additional benefit compared to those already on the market. Between 2012 and 2021, the GKV had to spend 16.6 billion euros on medicines without any additional benefits; in 2021 alone the sum was 3.8 billion euros. “Even if the AMNOG assessment process separates the wheat from the chaff, a large number of these new drugs obviously do not improve the quality of care,” said Schröder.
A third of patent-protected drugs for cancer
The drug with the highest sales in 2022 is Keytruda (pembrolizumab, used for cancer) with net costs of 1,308 million euros (+ 16 percent compared to the previous year, 471 thousand prescriptions), followed by Eliquis (apixaban, for cardiovascular diseases) with 1,257 million euros net costs (+ 12 percent, 5.5 million prescriptions) and Xarelto (rivaroxaban, for cardiovascular diseases) with 861.6 million euros net costs (+ 4 percent, 3.1 million prescriptions). All three medicines are under patent protection.
In total, around 8.1 billion euros were spent on 3.2 million prescriptions for cancer in the patent market. This results in a value of around 2,500 euros per prescription. This means that 15.2 percent of all drug costs are attributable to cancer therapies, which only account for a prescription share of 0.4 percent. Patent-free drugs against cancer had net costs of 2.4 billion euros for 5.3 million prescriptions. This results in a value per prescription of around 450 euros - almost a fifth of the price of the patent-protected anti-cancer agents. This is due to the fact that after the patent expires, the prices of drugs usually fall sharply due to competition with generic drug providers.
WIdO publication highlights developments in the pharmaceutical market
The current WIdO publication “The GKV pharmaceutical market: Classification, methodology and results 2023” sheds light on market events in the pharmaceutical sector. Not only are the reasons for market movements for certain groups of active ingredients described, but the prescribing specialist groups are also evaluated. In 2022, most medication prescriptions were made by general practitioners with 24,965 defined daily doses (DDD), followed by internal medicine specialists with 12,434 DDDs. The highest average net costs per doctor were recorded for hematology/oncology specialists at EUR 5,233 thousand. The WIdO publication also provides information on how many medicines each GKV insured person received in Germany in 2022: On average, 645 DDDs were prescribed last year. The 25 to 29 year olds had the lowest drug consumption with an average of 110 DDD per GKV insured person. The group of 80 to 84 year olds received the most prescriptions with an average of 1,877 DDDs. There were differences in prescriptions not only across age groups, but also between genders. With 690 DDDs, women received around 15 percent more prescriptions than men with 597 DDDs.
With the PharMaAnalyst, the WIdO also offers an online portal for analyzes of the pharmaceutical market. The PharMaAnalyst enables users to carry out precise evaluations of all GKV prescription data for the years 2012 to 2022. The 3,000 drugs with the highest prescriptions and sales every year, which the GKV drug index prepares in a quality-assured manner in the WIdO, are available for individual analyses. Evaluations can be carried out in PharMaAnalyst for specific finished medicinal products as well as for individual active ingredients or groups of active ingredients. It is also possible to display rankings of the 100 products with the highest sales or prescriptions as well as the most expensive products in the entire GKV pharmaceutical market.
The WIdO calculations are based on anonymized prescription data, which are billed in public pharmacies and hospital pharmacies for outpatient care at the expense of the statutory health insurance. The data is based on around 468 million prescription sheets and around 820 million individual prescriptions.