AOK Advocates Cost-Saving Over Fixed Fee Increase for Pharmacies

The debate over pharmacy remuneration in Germany has intensified following a proposal to raise the fixed dispensing fee for prescription medications from EUR8.35 to EUR9.50. This initiative, backed by the Federal Minister of Health, has sparked notable opposition from statutory health insurers, notably the AOK federal association, which argue that such an increase contradicts ongoing cost-saving efforts within the healthcare system.

During a recent event in Berlin, the Minister emphasized a commitment to honoring the coalition agreement, which includes the planned remuneration adjustment. Despite expectations of criticism due to stringent savings targets for the public health sector, the Minister reaffirmed her intention to implement the increased fixed fee.

Health insurers, however, are raising concerns about the financial implications. A spokesperson for the AOK association pointed out that Germany's economic conditions remain challenging, with statutory health insurance (GKV) contribution rates reaching record highs. The spokesperson noted that expenditure in the healthcare sector continues to rise, and an increase in pharmacy fees would be inconsistent with the Minister's stated objective that all stakeholders must contribute to savings initiatives.

The financial outlook for the statutory health insurance system is a cause for concern, with projections indicating a double-digit billion-euro deficit that must be addressed by 2027. According to AOK representatives, pharmacies should not be exempt from the collective effort to curb spending. Their focus has shifted to the fund for pharmaceutical services (pDL), which reportedly contains significant unused resources. The association suggests that these unspent funds should be returned to contributors rather than allocated elsewhere.

In contrast, the Federal Ministry of Health has different plans for the pDL fund. The draft legislation for the Pharmacy Supply Development Act (ApoVW) proposes that the EUR0.20 per prescription package, currently directed to the pDL fund, should instead support night and emergency pharmacy services. Furthermore, it envisions that pharmaceutical services will eventually become billable with the health insurers.

The DAK-Gesundheit insurance fund has already incorporated the anticipated higher fixed fee into its financial planning. Their calculations estimate that raising the fee to EUR9.50 per prescription would result in an additional EUR1 billion in annual expenditures. In response, DAK has presented a three-stage reform plan aimed at halting the upward trend in contribution rates and stabilizing the finances of the statutory health insurance system. Among the proposed measures are reductions in pharmaceutical taxes, which are intended to alleviate some of the financial pressures.

Andreas Storm, CEO of DAK-Gesundheit, described the current trajectory of rising contribution rates as alarming. Without comprehensive reforms, he predicts that the overall social security burden in Germany could surpass the 50 percent threshold by 2035. The DAK's reform package is designed to deliver both immediate and long-term stability to the healthcare financing system.

As discussions continue, the future of pharmacy remuneration and broader health system funding remains uncertain. The outcome will depend on the ability of policymakers, insurers, and healthcare providers to reconcile the need for sustainable financing with the goal of ensuring high-quality patient care and access to pharmacy services across Germany.