Table of Contents
- Executive Summary
- Strategic Considerations
- Stakeholder Implications
- Overview
- Organization and Funding of the German Health Care System
- Pharmaceutical Prices in Germany
- Reimbursement of Outpatient Medicines
- Cost-Containment
- Reference Pricing
- Extension of Reference Pricing to Patent-Protected Drugs
- A More Aggressive Reference Price Method
- Market Impact
- Incentives to Undercut Reference Prices
- Price Freeze
- Mandatory Rebates
- Voluntary Rebate Contracts, Cost-Sharing Deals, and Risk-Sharing
Agreements
- Prescribing Budgets
- Daily Cost-of-Therapy Limits
- Prescribing Guidelines
- Use of Generic Drugs
- Market Dynamics
- Pricing Trends and Generic Erosion
- Generics Substitution
- Parallel Imports
- Patient Copayments
- Negative List
- Dereimbursement of Nonprescription Medicines
- Health Technology Assessment
- Role of the Institute for Quality and Effi ciency in Health Care (IQWiG)
- Introduction of Health Economic Evaluation
- Regulatory Framework
- Opposition from Health Economists and the Pharmaceutical Industry
- Response of the GBA and IQWiG to Criticism
- Draft Methodology for Health Economic Evaluation
- Future Focus on Costly New Therapies
- Reimbursement of Hospital Medicines
- Pricing and Reimbursement
- Prospective Payment
- Pharmacy Decision Making
- Monitoring Pharmaceutical Use and Spending
- Interaction Between Hospitals and Primary Care
- Disease Management Programs
- Off-Label Prescribing
- Outlook for the German Pharmaceutical Market
- Appendix: Glossary of German Terms Used in This Report
Sidebar
- The Impact of Reference Pricing on the German Statin Market
Tables
- 1. Statutory Health Insurance Receipts and Expenditures, 1991-2006
- 2. German Health Care Reforms of Particular Signifi cance to the
Pharmaceutical Industry, 1988-2007
- 3. Multilateral Comparison of Average Ex-Manufacturer Prices of Branded
Medicines in Select Markets as a Percentage of U.K. Average Ex-Manufacturer
Prices, 1992-2004
- 4. German Prices of Best-Selling Drugs as a Percentage of U.S. and
European Average Prices, 2006
- 5. Prices of Leading Biologics in the Major Markets as a Percentage of
U.S. Prices, 2006
- 6. Maximum Wholesalers' Margins on Ex-Manufacturer Prices of
Prescription-Only Medicines
- 7. Maximum Pharmacists' Margins on Pharmacy Acquisition Prices of Drugs
That Are Not Subject to Prescription-Only Status But Are Prescribed and
Reimbursed by the GKV
- 8. Average Composition of Retail Pharmaceutical Prices in Germany,
1990-2007
- 9. Targets of Key Pharmaceutical Cost-Containment Measures in Germany
- 10. New Reference Pricing Groups Implemented in Germany Effective January
1, 2008
- 11. 2007 Retail Prices and New Reference Prices of Largest Pack Size of
Nebilet
- 12. Evolution of Savings from Reference Pricing in Germany, 1989-2007
- 13. Reference-Priced Drugs' Place in the German Pharmaceutical Market
- 14. Out-of-Pocket Payments for Reference-Priced Drugs in Germany
- 15. Select Rebate, Cost-Sharing, and Risk-Sharing Agreements on Branded
Drugs
- 16. Generics' Share of the Potential Generics Market and the Total GKV
Prescription Market, 1981-2006
- 17. Average Percentage Price Difference Between Median Prices of Generic
and Branded Versions of Off-Patent Drugs, 1981-2006
- 18. Key Trends in the German Prescription Drug Market. Implications for
the Pharmaceutical Industry
Figures
- 1. Average Prices of Leading Biologics, Small-Molecule Drugs, and
Pharmaceuticals Overall in the Major Markets as a Percentage of U.S. Prices,
2006
- 2. Evolution of Average Drug Prices in the Statutory Health Insurance
Pharmaceutical Market, 1983-2007
- 3. Percentage of Reference-Priced Drugs with Retail Prices Above, in Line
with, or Below Their Respective Reference Prices, January 1, 2008
- 4. Reference-Priced Drugs' Share of the German Statutory Health Insurance
Pharmaceutical Market, 2004-2007
- 5. Evolution of Retail Prices in the German Pharmaceutical Market, June
2006-December 2007
- 6. Reasons Given to Statutory Health Insurance Patients for a Change of
Prescription 2007
- 7. Reactions of Statutory Health Insurance Patients Whose Prescriptions
Were Changed, Drugs, 2007
- 8. Structure of the German Pharmaceutical Market, First Half of 2007
- 9. Percentage Decrease in Weighted Average Retail Prices of Eight
Best-Selling Off-Patent Drugs in Germany, March 2006 Through April 2007
- 10. Average Brand Market and Unit-Volume Share for Products That Have Lost
Patent and Exclusivity Protection
- 11. Average Prices of Brands and Generics as a Percentage of Respective
Brands' Price Prior to Generics Entry
- 12. Correlation Between Generic Price Erosion and Competitive Intensity
- A. Consumption of Statins in the Statutory Health Insurance Market,
2001-2006
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