Health Insurers Propose Elimination of Pharmaceutical Services and Reclaim Unused Funds

Germany's statutory health insurers have called for the complete removal of pharmaceutical services (pDL) in pharmacies and the return of unspent funds allocated for these services. This development comes amid ongoing discussions about reforms to the country's pharmaceutical service offerings and funding mechanisms.

The proposed changes are part of broader healthcare reforms under the Apothekenversorgung-Weiterentwicklungsgesetz (ApoVWG), which aims to expand available pharmaceutical services. The reform seeks to introduce five new services to supplement the existing five. Additionally, the legislation would enable physicians to prescribe these pharmaceutical services. However, a significant shift in funding has also been suggested: the current pDL subsidy of 20 cents per dispensed prescription medication would be redirected to support night and emergency pharmacy services.

The Spitzenverband der Gesetzlichen Krankenversicherung (GKV-SV), representing the statutory health insurers, has expressed long-standing reservations about the pharmaceutical service scheme. In a recent submission to the Health Finance Commission, which is tasked with identifying cost-saving measures for the Federal Ministry of Health, the GKV-SV advocated for the total abolition of the pDL program. Their position centers on optimizing financial resources and reducing unnecessary expenditures in the face of budgetary pressures.

According to the GKV-SV, a substantial sum--estimated at around half a billion euros--remains unused in the pDL fund. The association recommends that these unused funds be returned directly to the contributing health insurers. Moreover, they propose that any new pharmaceutical services should be negotiated individually between pharmacies and insurers, rather than being set by statutory regulations. This, they argue, would create more flexibility and efficiency in the system.

Specifically, the GKV-SV has suggested amending the legal framework to eliminate the fixed surcharge for pharmaceutical services outlined in § 3 of the Arzneimittelpreisverordnung (AMPreisV). They also propose revising § 129 (5e) of the Social Code Book V (SGB V) to empower health insurers to contract directly with pharmacies for new services. The association is seeking an immediate return of the pDL fund's volume to insurers on a fixed cut-off date, which could result in a one-time influx of approximately 550 million euros. Additional annual savings of up to 170 million euros could be achieved, depending on the number and nature of new services negotiated under the revised system.

The Health Finance Commission is due to present its initial findings in the coming months, as it explores ways to create fiscal space for future policy initiatives and avoid further increases in health insurance premiums. The outcome of these deliberations may have a notable impact on the structure and funding of pharmacy services across Germany.

Meanwhile, the Federal Ministry of Health is proceeding with the ApoVWG reforms, with expectations that the legislation will be approved by the federal cabinet. The ministry is optimistic that, despite some initial resistance, the reforms will enhance service provision and financial sustainability in the sector.

The debate reflects ongoing tensions between healthcare cost containment and the expansion of services available to patients. Stakeholders from both the pharmacy and insurance sectors are closely monitoring the developments, as the changes could significantly influence operational models and funding flows within the German healthcare system.