Hospital.Help

Berlin – Despite the measures of the Statutory Health Insurance Financial Stabilization Act (GKV-FinStG), spending on patented drugs is apparently continuing to rise. This is shown by the AMNOG report from DAK-Gesundheit, which also examined “blind spots in the pharmaceutical market”. It was prepared by scientists from Vandage and the University of Bielefeld.

According to the analysis, spending on patented medicines increased by 18 percent to an average of 2.54 billion euros per month in the months February to April 2024 compared to the same period in 2023. They accounted for 50 percent of total spending on medicines.

In the period from February to April 2022 – and thus before the adoption of the GKV-FinStG – the monthly GKV expenditure on patent-protected medicines – at the level of the pharmacy sales price – was still 1.86 billion euros. In the same period in 2023, it amounted to 2.16 billion euros. According to the report, expenditure has increased significantly more than the number of packs or daily doses dispensed.

“There has never been a legislative period with such an increase in expenditure and contribution dynamics,” explained Andreas Storm, Chairman of the Board of DAK-Gesundheit, today at the presentation of the report.

The DAK is forecasting an increase in the average additional contribution rate to 2.3 percent for the coming year. In the legislative period from 2022 to 2025, the additional contribution would therefore rise by a full percentage point. “In my opinion, there is no way around limiting the increase in expenditure,” stressed Storm.

The statutory health insurance (SHI) now spends more than every sixth euro on pharmaceuticals – despite the increased manufacturer discount, these are the second largest block at 17.38 percent of total expenditure, even ahead of statutory health insurance treatments at 16.33 percent.

The AMNOG report shows a blind spot that has often been underestimated and ignored with the development of expenditure on patented medicines in the hospital sector.

According to the DAK, this area will continue to grow in importance in the future, as the proportion of high-priced patented drugs in the inpatient sector continues to rise. The reason for this is new oncology drugs or gene therapies, for example. These blind spots are “a major problem that is becoming increasingly apparent,” emphasized the impartial chairman of the Federal Joint Committee (G-BA), Josef Hecken.

According to the information, hospitals alone spent 1.2 billion euros on patented medicines last year. This represents an increase of 132 percent within five years in an area of ​​expenditure that has previously received little research.

“We need transparency about the actual costs in the pharmaceutical sector, its blind spots such as the hospital sector and an open discussion about how the statutory health insurance should deal with these. And we need concrete measures to stabilize spending in the long term,” said Storm.

He described the spending dynamics on the pharmaceutical market as an “enormous challenge” for the financial stability of the statutory health insurance system. Due to the inconsistent political measures, there is now enormous pressure to act,” he said.

Contrary to what the federal government claims, there is no noticeable relief from the GKV-FinStG, explained health economist Wolfgang Greiner. In fact, since the law came into force, spending on patented drugs has not only risen continuously, but has recently even risen disproportionately.

Greiner examined monthly expenses indexed to January 2022 and found that the index had risen by 40 points over the past two and a half years. “That’s dramatic, you have to say that,” he stressed.

On the other hand, what the pharmaceutical industry had warned about did not happen. Due to the tightening of the so-called AMNOG guard rails, there was no mass withdrawal of medicines from the market.

In the case of products that are taken off the market, this is more likely to happen because they have been overtaken by technical innovations. However, there is no evidence of a “frustration effect due to the GKV-FinStG”.

Storm urged a revenue-oriented spending policy. “Expenditure on services must not rise faster than revenue, because the insured and the economy cannot cope with that in the long term,” said Storm. This must also have consequences for the pharmaceutical sector.

According to the information in the report, annual treatment costs for new drugs also reached a record high last year. These now average almost 400,000 euros per patient. At the same time, 20 of 38 initial assessment procedures since the introduction of the FinStG ended with no proven additional benefit. © lau/aha/may/aerzteblatt.de