Federal Council Opposes Increased Pharmacy Rebate in GKV Savings Law

The German Federal Council has issued a formal response to the proposed GKV Savings Law, with particular attention to the planned increase in the pharmacy rebate. The draft legislation seeks to raise the mandatory rebate that pharmacies must grant to statutory health insurance funds by 30 cents, bringing it to 2.07 euros per prescription starting January 2027.

Federal states have voiced strong reservations about this measure, emphasizing the ongoing financial challenges faced by pharmacies nationwide. The Council's Health Committee recently recommended the removal of the clause concerning the rebate hike, a stance that was reaffirmed during discussions in the Federal Council's plenary session.

In its official statement, the Federal Council underscored that additional financial pressures on pharmacies are neither appropriate nor responsible, particularly in the current economic climate. The Council highlighted several developments that, in its view, justify this position. The primary concern is that further increasing the rebate could exacerbate the already precarious financial situation of many pharmacies, potentially accelerating the trend of pharmacy closures across Germany. This issue is especially acute in rural and structurally weaker regions, where access to pharmaceutical care is already considered fragile. The Council warned that raising the rebate could undermine the goal of ensuring the local supply of medicines.

The Federal Council also pointed to the recent increase in the fixed pharmacy fee, which has been made official and is intended to strengthen the sector structurally. However, the Council noted that the timing and implementation details of this increase remain unclear in the context of the new legislation. Without solid and predictable framework conditions, the Council argued that it would be unjustifiable to impose a higher rebate on pharmacies at this time.

Another issue raised by the Council is the perceived inconsistency in the proposed approach. The Council argued that it is contradictory to impose a higher rebate on pharmacies while the compensatory increase in the fixed fee has not yet been clearly scheduled. Such uncertainty, they contend, would further undermine the economic planning security of pharmacy operators.

Given that the fixed fee increase has now been formalized, the Federal Council suggested that the situation should be reassessed. The Council stated that any consideration of raising the pharmacy rebate under Section 130 of the Social Code Book V should only occur if the pharmacy dispensing fee, as regulated by the Medicines Price Ordinance, is also increased from its current rate of 8.35 euros to 9.50 euros.

While the GKV Savings Law aims to achieve savings across all areas of statutory health insurance, the Federal Council acknowledged this goal in principle but stressed the importance of equitable burden-sharing. The Council referenced recommendations from the Health Finance Commission, which had previously suggested gradually increasing pharmacy remuneration rather than raising the rebate. As a result, the Council concluded that either the rebate should not be increased or, if it is, it must be offset by a corresponding increase in the dispensing fee in order to distribute the financial impact fairly across the sector.

The implementation of these recommendations remains uncertain. Mecklenburg-Western Pomerania's Minister of Health, Stefanie Drese, emphasized that it is crucial to ensure the recent increase in the fixed fee is not subsequently offset by a higher rebate, as this would negate the intended support for pharmacies.

As the legislative process continues, discussions between the federal government, the Federal Council, and various stakeholders are expected to address these concerns in greater detail. The outcome will have significant implications for the economic stability of pharmacies and the accessibility of pharmaceutical services, particularly in underserved regions.