Cash registers do not pay for over-the-counter medicines

Patients have to bear the cost of over-the-counter medicines themselves

18/01/2013

The health insurance company does not have to pay over-the-counter medicines. A 74-patient has failed with his complaint to the Federal Constitutional Court against the denied reimbursement of his statutory health insurance. Although his family doctor had considered a further treatment of the plaintiff with the non-prescription drug gelomyrtol for meaningful and necessary, the health insurance is therefore not obliged to reimbursement.

The legally insured plaintiff suffers from a chronic respiratory disease (emphysema bronchitis), against which his family doctor the use of „Gelomyrtol forte“ has prescribed. Since 2004, however, the drug is no longer prescription and therefore deleted from the catalog of benefits of statutory health insurance. Instead of the additional payment of five euros per pack de plaintiff since then had to pay the full price. According to him, this resulted in monthly costs of 28.80 euros. Chronic sick will be required here a special sacrifice and there is an inadmissible equal treatment of acute sick and chronically ill before, justified the 74-year-old his complaint to the Federal Constitutional Court.

No special sacrifice of the chronically ill
Since his health insurance company despite prescription by the doctor refused to take over the cost of the over-the-counter drug, the 74-year-old moved first to the Social Court, then before the National Social Court and finally before the Federal Social Court, which rejected a revision of the complainant in November 2008. As a last resort, the Federal Constitutional Court has now ruled that „the constitutional complaint was not accepted for decision“ will, as she is „partly inadmissible, partly unfounded“ be. The order of the plaintiff „Sonderopfer“ The chronic patient in favor of the general public was not recognizable. Especially since chronically ill people spend the cost of non-prescription drugs for themselves. „But if a person only purchases medicines that are useful to them, there is no special sacrifice for the community“, so the message of the Federal Constitutional Court.

Health insurance companies do not have to do everything for their health
Also, the statutory health insurance funds, according to the Federal Constitutional Court „not by constitutional means to do anything that is available to means of maintaining or restoring health.“ In the opinion of the court „reasonable self-services are required.“ The fifth Social Code (SGB V) does not prevent inadmissible discrimination of the chronically ill. Nor is the general principle of equality of Article 3 (1) in the Basic Law violated. The „Unequal treatment between prescription and non-prescription medicines, which in fact leads to higher co-payments for the chronically ill, is justified“, The judges of the Federal Constitutional Court ruled. The regulation on the prescription of drugs in „§ 48 Law on Marketing of Medicinal Products - Medicines Act (AMG) - in connection with § 1 Ordinance on the Prescription of Medicines - Drug Prescription Ordinance - serves to protect the population“, so the official communication of the court.

Prescription should ensure drug safety
By the regulation of the prescription obligation is to be ensured according to the Federal Constitutional Court, „Medicines that pose a health risk can only be used by those healing professionals who know their exact effects, side effects and interactions with other medicines, contraindications and other hazards.“ The legislature uses the prescription thus a criterion that „Its primary function is to ensure drug safety, also with the aim of controlling the financial utilization of the statutory health insurance.“ Here, the differentiation in the narrower sense of proportion, because the burden of the additional costs for non-prescription drugs in the current case „in proportion to the objectives pursued by the legislator with this differentiation.“ There was no indication that the applicant was disproportionately burdened with costs. (Fp)

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Image: Sara Hegewald