Figure for November 2014: 23.1 percent

28.11.2014 17:56

Never before have those with statutory health insurance had to make so many out-of-pocket co-payments for medications at the pharmacy. Currently, only 6.9% of all generic drugs are exempt from patient co-payments. Due to the regular reduction of fixed reimbursement amounts by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), many generic drug companies have no leeway to relieve patients of co-payments through additional price reductions below the fixed amount.

Pharmaceutical manufacturers generally have the option of relieving patients of co-payments if they lower their prices by a further 30 % below the fixed amount set by the umbrella organization.

However, recent analyses by the market research company INSIGHT Health show that the proportion of generic drugs exempt from co-payments, which was 30% in autumn 2007, has been steadily declining for years and reached its lowest level since the introduction of co-payment exemptions in September 2014 at 6.9%. As a result, patients have never before had to pay a co-payment for so many inexpensive generic drugs.

Many insured individuals are familiar with this effect from dental visits. Here, too, health insurance companies often only cover a portion of the costs. The result: patients have to pay more and more out of their own pockets. In the area of pharmaceuticals, the reason lies in the fixed reimbursement policy of the National Association of Statutory Health Insurance Funds: the annual reduction of the fixed reimbursement amounts results in a "downward spiral" effect for generic drug prices, because lower generic drug prices are then factored into the calculation of the next reduction of the fixed reimbursement amounts in the following year.

And with many generic drugs, health insurance companies actually earn twice: For example, for a pack of cholesterol-lowering medication, for which the manufacturer receives a maximum reimbursement of €0.76 according to the fixed price – without taking into account additional discounts from rebate agreements – a patient co-payment of €5 is due. Apparently a good deal – but only for the health insurance companies.