Copayment Exemption Limits for Pharmaceuticals 2012

New Coping Exemption Limits for Pharmaceuticals from 2012 onwards

08/01/2012

According to the Federal Association of German Pharmacist Associations (ABDA), the limits on the exemption from premiums for medicines for health insurance patients changed at the turn of 2012. A change had become necessary because the federal government changed the wholesale surcharge in the statutory drug price regulation. Accordingly, the health insurances calculated new limits to the liberation of medicines.

Ask at the pharmacy for a non-cash alternative
There are many medicines on the drug market that are exempted from a surcharge. Patients who are members of a statutory health insurance company can currently see on the ABDA website which drug is currently exempted from an additional payment. The adress is: „“. If you do not have an Internet connection or you would rather ask for more information, you can ask for a prescription at the pharmacy when redeeming the prescription, if an alternative supplement without additional payment is available.

Currently, in Germany exactly 32,336 funds with a fixed amount occupied. This means that for all public health insurance companies, a so-called maximum reimbursement amount applies. Almost a fifth of fixed-price medicines are exempt from co-payments. According to the pharmacists' associations, since the beginning of 2012, 6,212 medicines have been free of charge (19.2 percent). Medicines can, in principle, be exempted from additional payments if the price of medicines is 30 per cent below the fixed price. Both values ​​are determined by the association of the statutory health insurance (GKV).

Who is basically exempt from additional payments?
Minors Children and adolescents in the statutory health insurance are generally exempt from the additional payments for medicines and practice fees. In addition, the chronically ill, social welfare or Hartz IV recipients can apply for exemption if they spend more than one percent of their annual income on medication and medical fees. To be able to prove that the annual income was exceeded by one percent, sufferers must lift all receipts from pharmacies, clinics and medical practices. Wolfgang Müller von „gegen-hartz.de“: „The vouchers should be with stamp and signature, otherwise a non-recognition by the health insurance could be done“, warns the expert on social benefits. When all bills have been collected, they are submitted to the cashier at the end of the year. „If the insured person has reached more than two percent in the calculation year, all costs will be reimbursed retroactively“.

Pharmacies are required to collect the additional costs
For medicines without obligation to pay, the following applies: If the receipt does not contain an entry for exemption from copayment or the patient does not have a certificate of exemption, the pharmacies must claim the copayment in full. These are „the pharmacies are required by law“. About 1.8 billion euros will be passed on to the health insurance companies.

The additional payments for medicines amount to 10 percent. However, the legislator has taken care not to overburden the insured with expensive medicines, which is why the maximum amount for an additional payment is 10 euros. The lowest rate is set at five euros per item. The amount must never be higher than the actual price of the drug, said the Federal Association of German Pharmacists. (Sb)

Also read:
Beware of counterfeit medicines
If you have vision problems: mark your medications colorfully
Exemption from co-payments in Hartz 4

Picture: Gerd Altmann