Reform der Erstattungs und Preisregulierung von v

Authors: Stefan Greß D Niebuhr U May J Wasem

Publish Date: 2013/03/25

Volume: 5, Issue: 1, Pages: 13-27

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Abstract

Dies ist eine Übersetzung des Originalartikels der bereits in der internationalen Ausgabe von PharmacoEconomics erschienen ist Reform of Prescription Drug Reimbursement and Pricing in the German Social Health Insurance Market A Comparison of Three Scenarios Stefan Greß Dea Niebuhr Uwe May und Jürgen Wasem PharmacoEconomics 2007 256 443–454We review regulation of two important parameters for thirdparty payers and Abstract manufacturers of prescription drugs regulation of reimbursement and pricing We find that centralised regulation of reimbursement and pricing prevails in the 15 original EU member countries EU15 and in European Free Trade Association EFTA countriesCompared with countries such as Switzerland The Netherlands France and England regulation in the German social health insurance system is rather unique First market approval is nearly always equivalent to reimbursement Second manufacturers are free to determine prices but internal reference prices restrict them from actually doing so for generics and therapeutic substitutes In order to contain rising expenditures for prescription drugs in Germany and to set incentives for physicians to consider the costs as well as the benefits of prescriptions three reform scenarios are feasibleThe first scenario maintains centralised reimbursement and centralised pricing the second maintains centralised reimbursement but switches to decentralised pricing similar to social health insurance in Israel and Medicare in the US Thirdparty payers would be able to negotiate with manufacturers about discounts and market shares for genetic and therapeutic substitutes In the third scenario pricing and reimbursement would be decentralised similar to private health insurance in the US

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