Figure of the month April: 2 billion euros

28.04.2015 12:02

Patients had to pay €2 billion in additional payments out of their own pockets for medicines in 2014.

Patients have had to pay more and more for medicines for years, now over 2 billion euros.

One reason for this is the restrictive fixed-amount policy of the statutory health insurance (GKV), which lowers the fixed amounts for medicines.

Drug manufacturers no longer have any scope to lower their drug prices below the co-payment exemption limits - Result: Not even 3,500 drugs are still exempt from co-payment.

The central association of statutory health insurance companies determines the amount of the fixed amounts. A fixed amount indicates the maximum reimbursement amount that the GKV will reimburse for a drug. In addition, so-called “additional payment exemption limits” are defined, which are a further 30 % below the fixed amount. If the drug manufacturer then lowers the price of its drug below the co-payment exemption limit, the insured person will not have to pay any co-payment.

The amount of the fixed amounts is reviewed annually and in most cases is significantly reduced by the GKV. The repeated rounds of reductions mean that there is no longer any scope for manufacturers to reduce their price again by 30 % below the heavily reduced fixed amount. The number of medicines exempt from co-payment is decreasing, and patients have to pay for more and more medicines out of their own pocket.

A lucrative business for the GKV. In many cases, the fixed amount for medicines is far less than one euro. The GKV therefore pays less than one euro for the medicine, while the patient has to pay an additional payment of 5 euros.

In 2014, the GKV collected over 2 billion euros from additional payments for medicines. This roughly corresponds to the entire net sales of the generics industry, which, however, has to provide 76% of the total drug supply in Germany.