Health insurance Higher co-payments for drugs

Health insurance companies: Increasingly higher co-payments for medicines

14/02/2011

Cash patients had to pay more for drugs in the year 2010 than in the previous year. This is reported by the Federal Association of Pharmacists and relies on their own analysis of the data.

Insured persons of the statutory health insurance companies had to pay considerably more for prescription medicines in the past year than in the previous year. In total, patients paid about 1.8 billion euros for medicines in 2010. This is about 71 million euros more than in the previous year 2009. The reports of the German Pharmacists Association (DAV). The association was able to evaluate the data because the pharmacies are legally obliged to transfer the additional payments to the statutory health insurance funds.

Slight increase in co-payments for several years
For years, the additional payments for drugs for statutory health insurance increased. In 2007, cash patients in Germany still had to pay 1.625 billion euros in additional payments. In 2008, it was almost 1.7 billion euros (1.675). Insured persons paid around 1.696 billion euros in 2009 and 1.767 billion euros in 2010. The main reason for the increase last year may have been the reduction by the statutory health insurance (GKV) of numerous fixed amounts and co-payment exemption limits as of September 1, 2010. In addition, prices for medicines have risen slightly on average.

On average, every GKV insured person paid € 2.40 per pack of medicines. In the three years before (2007, 2008 and 2009), it was 10 cents less than the average of 2.30 euros per drug. Every cash-point patient has to pay 10 per cent of the regular sales price for prescription medicines. The minimum limit is five Euto, the maximum limit for co-payments at 10 euros per pack. However, the copayment amount must never be higher than the actual sales price to be paid.

Discounts and exemptions from co-payments for medicinal products
The legislator stipulates that under certain circumstances exemption of the additional payment for medicinal products applies. Every child and every adolescent without being over the age of 18 is released. If an insured person has to spend more than two percent of his annual gross income on medicines, the threshold is exceeded. Thereafter, the insured person can request exemption of the additional payment from his health insurance. If the person is chronically ill, the exposure limit is one percent.

If the drug price is lower by 30 percent than the fixed amount, it is possible to include the drug in the payment release list. Again, a request must be made to the appropriate health insurance. Depending on the health insurance provider, discounts for medicines can also be negotiated. For more information, please contact the respective funds. (Sb)

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Image: Viktor Mildenberger