Pharma discounts: benefit those insured with private health insurance

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According to the will of the Federal Minister of Health, private health insurance (PKV) is to receive a significantly higher proportion of pharmaceutical discounts in future than previously assumed. The 8.8 million people with private health insurance could benefit from these new regulations, because the discounts are intended to avoid increases in premiums for insurance policies.

If the federal government has its way, the negotiated pharmacy discounts for statutory health insurance companies should also apply to private health insurance companies in the future. In addition to the discounts, a manufacturer discount of 16 percent is to be added, which was negotiated on August 1st by the National Association of Statutory Health Insurance Funds (GKV). According to the coalition circles, the insured should benefit in particular, because the discount contracts should prevent an increase in insurance premiums. The black-yellow coalition announced that it should be ensured "that the relief provided by the pharmaceutical discounts will actually benefit all insured persons, including those with private insurance".

The Federal Ministry of Health emphasizes that this is not about a regulation to strengthen the private health insurance companies, but to relieve the insured. However, in the past, private health insurance had repeatedly urged the government to also benefit from pharmaceutical discounts. So it seems that the intercessions to the federal government have now had a visible success. The new regulations are very likely to be implemented in the course of the health reform.

Furthermore, in connection with the reform, the statutory health insurances are to conduct price negotiations with the respective pharmaceutical manufacturers for each new drug. However, these are drugs that have been found to have an additional benefit for patients compared to other preparations. From this new regulation and from the manufacturer discount, which was increased by 16 percent on the first of August, which is linked to a price freeze and which was limited to the end of 2013, the private health insurance company should now also benefit. The discount applies to medication for which no fixed price has been agreed.

A participation of the private health insurance in future discount negotiations is planned; however, the association of private health insurance criticizes the discount stipulations, as these should be done "in good faith". "Codetermination" would look different, according to the association. Because the price negotiations are still being conducted by the National Association of Statutory Health Insurance Funds. However, the private health insurance would prefer to enter into negotiations with the pharmaceutical manufacturers themselves and negotiate economically oriented contracts.

Discount for private health insurance, no business promotion
The private health insurance companies should be allowed to use the savings "only to avoid or limit premium increases or to reduce premiums," the coalition announced. There can be no question of a policy in the sense of private health insurance, since it is primarily about the interests of all insured persons.

Criticism of the inclusion of discount contracts for private health insurance
The statutory health insurance funds are not at all enthusiastic about the innovations and have expressed sharp criticism. The reforms are a "state support package", says Florian Lanz from the GKV Association. Lanz sees it as "astonishing" that the private health insurance can no longer manage without the negotiating competence of the statutory health insurance. On the one hand, the private health insurance does not have to use the solidarity principle of health insurance, on the other hand they still want to benefit from the discount stipulations.

The Association of Research-Based Drug Manufacturers (VfA) sees its skins floating away. Due to the planned discounts, annual sales losses of around 500 million euros are expected there. The association also criticizes the fact that the private health insurance as a commercial enterprise now benefits from state regulations, although it does not have to serve the solidarity principle of the health care system. Because in the PKV are ostensibly high earners and civil servants who have more financial resources.

Private health benefits greatly from the health reform
In summary, it can be said that the black-yellow coalition wants to give private health insurers enormous benefits. Because the discounts are not the only changes in terms of PKV. From next year, for example, it should be made easier for employees to switch to private health insurance. Instead of the three-year rule, a one-year rule comes into force. This means that an employee with a gross wage of at least 4162.50 euros per month can decide after one year whether to stay in the GKV or switch to the private health insurance. A change could be worthwhile, especially for young and childless policyholders. However, numerous good contributors are lost to the statutory health insurers. That could turn into another financial problem for the statutory health insurance. How the regulations look in detail and when they will be implemented is currently unknown. However, it can be assumed that they will be implemented in the course of the health reform. A corresponding draft law is currently being drawn up by the Ministry of Health. (sb, 10/09/2010)

Also read:
Medicinal discounts also for private health insurance
Private health insurance: is it worth switching?
Save with private health insurance
PKV: Services and quality a reason to change?
Federal government: Billion package for private health insurance

Photo credit: Benjamin Klack /

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