Price changes due to legal regulations since the introduction of AMNOG

 

DateReason
01 Jan 2012Adjustment wholesale surcharge: fixed € 0.70 plus 3.15%, max. +37.80 € (AM-PreisV)
01 Jan 2013Increase of the fixed pharmacy surcharge to EUR 8.35 (+0.25 €)
01 Aug 2013Einführung Apotheken-Notdienstzuschlag: +0,16 €
01 Jan 2014Reduction of manufacturer discount §130a (1a) SGB V from 16% to 6%
01 Apr 2014Re-increase of manufacturer discount §130a (1a) SGB V to 7%
01 Jan 2020Increase of pharmacy emergency service surcharge to 0,21 € (+0,06 €)
01 Jul 2020Temporary VAT reduction to 16%
01 Jan 2021VAT raised again to 19%

Manufacturer discount according to §130a SGB V ("mandatory discount")

  • With the "Act to amend the health insurance law and other regulations" (GKV-Änderungsgesetz), an increased mandatory discount (Herstellerrabatt) of 16% on the pharmacy retail prices of prescription medicines not subject to the fixed-price regime was introduced in §130a, paragraphs 1a and 3a SGB V for the period from 01 August 2010 to 31 December 2013. This rebate must be paid by the manufacturer.
  • From 01 January 2014 to 31 March 2014, the this mandatory discount was temporarily set at 6% for all medicines dispensed at the expense of the statutory health insurance.
  • From 1 April 2014, this mandatory discount was set at 7% in accordance with §130a SGB V.
  • An additional discount of 10% on the pharmacy retail price of off-patent drugs with the known active ingredients (generics) has been in effect since 1 April 2006.
  • At the same time, there is a price moratorium until the end of December 2022 for drugs not subject to the reference price system. The moratorium freezes the price level on 1 August 2009 (§ 130a paragraph 3a SGB V). If pharmaceutical companies increase their ex-factory prices for medicinal products that fall under this moratorium, they must pay back these increases to the health insurance funds in the form of a corresponding additional discount. For the first time on 1 July 2018 and on 1 July of each of the following years, the price level on 1 August 2009 can be increased by the changes in the consumer price index for Germany as compared to the previous year. Under paragraph 130a(4) and (9) of the SGB V and in implementation of Article 4 of Directive 89/105/EEC, exemptions may be granted in individual cases on special justification.
  • The Federal Ministry of Health (BMG) is responsible for decisions on applications under paragraph 130a (4) and (9) SGB V, which has transferred this responsibility to the Federal Office of Economics and Export Control (
  • The discount pursuant to paragraph 130a SGB V is settled via the pharmacy IT centers, which are subsequently reimbursed by the manufacturers. Pharmacies must make advance payments and run the risk of not being able to collect their claim if a manufacturer has payment difficulties. The pharmacies therefore perform a collection function for the health insurance funds, which is not remunerated.

Großhandelsaufschlag, Apothekenaufschlag, Nacht- und Notdienste

  • For prescription medicines, the manufacturer sets a ex-factory price or a manufaturer's selling price (Abgabepreis des Pharmazeutischen Unternehmers; APU).
  • According to §2 AMPreisV, pharmaceutical wholesalers levy a wholesale surcharge of 3.15% but not more than € 37.80 as well as an additional fixed surcharge of € 0.70. The result is the pharmacy purchase price (Apothekeneinkaufspreis; AEP).
  • According to Section 3(1) of the German medicines price regulation AMPreisV, pharmacies charge another 3% surcharge on the AEP plus a fixed surcharge of €8.35 (2004 to 2012: €8.10). Since 01 August 2013 pharmacies have to pay € 0.16 to a Night and Emergency Service Fund, which in turn distributes the money among the pharmacies as a subsidy for their night services. This surcharge has been increased to € 0.21 per Rx drug package as of 1 January 2020. The distribution volume of the Night and Emergency Service Fund increased accordingly. According to the Ministry of Health (BMG), the emergency service surcharge is to rise to around € 350. For the dispensing of particularly documentation-intensive medicines (BtM and T prescriptions), the surcharge was raised from €2.91 to €4.26 at the same time. In addition, an aut-idem replacement of prescribed medicines in pharmacies has been made possible for those insured under private health insurance schemes, recipients of subsidies and self-payers, and a regulation on the labelling of prescription medicines has been simplified.
  • The resulting price is the pharmacy retail price (Apothekenverkaufspreis; AVP) according to the AMPreisV.

Pharmacy discount for the GKV

  • For patients insured in the GKV, pharmacies must grant a discount on the pharmacy sales price to the health insurance fund in accordance with §130 SGB V. This is called "Kassenabschlag" in the language used by pharmacies and "Apothekenabschlag" by health insurance funds. It is often interpreted as a discount for large customers, although patients are served individually in the pharmacy. Historically, this discount has been established as a price reduction for the statutory health insurance system, in the same manner as doctors in Germany are better rewarded for treating privately insured patients. It also has a discount function for the pharmacies, as it is only be granted if the health insurance company pays its bills within ten days.
  • In 2011 and 2012, the pharmacy discount (including statutory VAT) rose to € 2.05 from € 1.75 in the past.
  • In the first half of 2013, the discount fell back to € 1.75, and then rose to € 1.85 from 1 July 2013.
  • In 2014, the pharmacy discount was € 1.80.
  • From 01 January 2015, the pharmacy discount has been set at € 1.77 by arbitration. This discount level was also fixed for the following years by a law to strengthen the statutory health system (GKV-Versorgungsstärkungsgesetz).

Temporary VAT reduction

  • Article 3 of the Second Act on the Implementation of Tax Aid Measures to Manage the Corona Crisis of 29 June 2020 (Zweites Corona-Steuerhilfegesetz, BGBl. I, p. 1512) has reduced the general VAT rate in Germany from 19% to 16% beginning on 1 July 2020 and ending on 31 December 2020 (section 12 (1) in conjunction with section 28 (1) UStG) and the reduced VAT rate from 7% to 5% (section 12 (2) in conjunction with section 28 (2) UStG).