Patient choice is through exclusive contracts

Exclusive contracts of the AOK Hessen for the cytostatic drug delivery are not binding for the patients

09/02/2014

For months, the conflict between the AOK Hessen and the Association of Cytostatic Pharmacists (VZA) smoldering over the regulations for the production and delivery of cytostatics formulations by the statutory health insurance. The Darmstadt Social Court has now decided, according to the announcement of the Deutsche Apotheker Zeitung (DAZ) that „the zero-retaxation of a pharmacist who provided cytostatic preparations to AOK insured, even though he has no contract with the AOK Hessen, unlawful“ was.

According to the data of the DAZ, the Social Court of Darmstadt weighted the patients' suffrage significantly more difficult than the existing exclusive contracts for cytostatics production. Thus, the AOK Hesse were clearly shown the limits of the regulations by exclusive contracts. The court has ruled that patients' free choice always applies. The VZA is quoted in the article of the Deutsche Apotheker Zeitung with the statement that here „the attempt failed to undermine the patient's right to vote and to exclude all pharmacies except for some tender winners.“ The verdict is one „Milestone for the right of self-determination of sick people and to end the tendering process.“

Conflict in the care of cancer patients
The dispute between the AOK Hessen and the VZA erupted after the health insurance company decided at the end of 2013 to conclude an exclusive contract with individual pharmacies for the preparation and delivery of the cytostatics. After passing through a public tender for the provision of services, twelve pharmacies were selected to take over the care of the AOK insured. Other pharmacies that donated cytostatics to AOK insured persons without a corresponding contract have since been retaxated. In the end, the AOK wanted to reach Hesse via the financial leverage to comply with the exclusive contracts. From the beginning, the procedure met with massive criticism from the VZA and other pharmacist associations. „The tender issued by the AOK Hessen for the supply of cytostatics undermines the free decision of the insured for a pharmacy of their confidence, puts the proven cooperation between doctor and pharmacist for the good of the patients on the line and endanger the local and rapid supply of medicines“, so the charge of the VZA.

Suffrage of patients applies in spite of exclusive contracts
In the first instance, according to the announcement of the DAZ on August 29, the Social Court Darmstadt has decided on the action of a pharmacist, whose billed recipes for cytostatic preparations by the AOK Hesse were retaxed to zero. The General Court fully complied with the applicant and clearly stated that the Social Code V could not be decided against the will of the patient. Relying on the oral judgment of the presiding judge, the DAZ reports that the insured persons have a right to choose among the licensed service providers and this also applies to the supply of cytostatic drugs, „because there is no other explicit legal restriction of patient choice.“ The complaining pharmacist is therefore entitled to the full payment of his billed cytostatics preparations.

Functioning supply structures endangered
In the view of the VAZ, the AOK Hessen care concept for cancer patients in anticancer drugs overall contrasts with the requirements of close communication and coordinated coordination by oncologists and local pharmacies. The functioning supply structures would be smashed by the tendering model, the DAZ quoted the VZA president Dr. Ing. Klaus Peterseim. To possible „profitability reserves“ The quality, safety and trust of the patients in the oncological care are lost here. „A bidding-based approach to patient care in oncology is completely wrong“, stressed Peterseim and added: „ I am pleased that the Social Court Darmstadt has stopped this anti-paternal practice in Hesse.“ (Fp)