New TK contract on biological regulations

12.07.2016 09:29

The Techniker Krankenkasse (TK) and the professional association of resident gastroenterologists in Germany eV (bng) have concluded an agreement to improve the quality of care and cost-effectiveness of prescribing biologics for patients with chronic inflammatory bowel disease (IBD).

“The contract creates opportunities for improvement in the care of patients with Crohn's disease and ulcerative colitis. These require intensive support and close support from specialized doctors,” says Priv.-Doz.Dr. Bernd Bokemeyer from bng. “This specialized care for patients with chronic inflammatory bowel disease is particularly necessary given that the prescribed medicines are usually highly effective, but also not free from side effects.”

The TK and the bng have agreed that the respective original and the biosimilars should be taken into account equally in the regulation. Of course, their use must be therapeutically necessary and indicated. This results in a biosimilar quota of 67 percent for new patients - this is determined across all participating doctors. If they meet the quota, the participants receive additional compensation. If you have to treat patients differently for medical reasons, this does not reduce your reimbursement. An intuitive traffic light scheme supports the doctor in adhering to the agreed prescription quota.

“With the traffic light scheme, we create a simple overview of the cost-effectiveness of the biologics for the participating doctors and at the same time maintain their freedom of treatment,” says Daniel Cardinal, Head of Care Innovations at TK. “Biologics are among the high-priced specialty preparations that make up a significant portion of TK’s drug expenditure.”