At the beginning of December, the Federal Health Minister, Karl Lauterbach, announced that the current publicly listed AMNOG rebates could be replaced by confidential rebates as part of the federal government’s pharmaceutical strategy, which aims to ensure the attractiveness of the German pharmaceutical market.
Indeed, keeping rebates confidential was already demanded by the industry in 2011 when the AMNOG benefit assessment was introduced, due to their concerns about the international reference effect of German reimbursement amounts and the potential for a downward price spiral in other countries.
This week, a draft of the Medizinforschungsgesetz (MFG; Medicines Research Act) was released, stipulating, among other things, that negotiated rebates can be confidential.
This has been criticised by the AOK Federal Association, the largest statutory health insurance provider. According to Jens Martin Hoyer, the Deputy Chairman of the AOK Federal Association, the implementation of confidential rebates:
May result in significantly more bureaucracy and additional expenses for health insurance companies, which will need to set up additional administrative processes
Will not lead to improved patient care
Will make it difficult to ensure the adoption of cost-effective drugs:
- The Federal Joint Committee will no longer be able to identify the most economically appropriate comparative therapy as part of the benefit assessment • Doctors or pharmacies will no longer be able to estimate the costs of therapies and prescribe or dispense the most cost-effective options.
So what does this mean?: Despite the potential for drawbacks, the act seems to be pushing forward to allow confidential rebates. This would benefit manufacturers as net prices in Germany, by being kept confidential, will not impact prices in other markets.