Expenditure On Retail Pharmaceuticals Per Capita, 2017 (USD$ PPP)
Prescribed Medicines: $735
Over-The-Counter Medicines: $87
Medical Non-Durable: $0
Total: $823

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Expenditure On Retail Pharmaceuticals By Type Of Financing, 2017 (%)
Government/Compulsory Plans: 84%
Voluntary Health Insurance Plans: 0%
Out-Of-Pocket: 16%
Other: 0%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“The overall amount of SHI [Statutory Health Insurance] pharmaceutical co-payments continuously increased from €0.6 billion in 1991 to €2.7 billion in 1998. The then newly elected Social Democratic/Green Coalition Government lowered nominal co-payment rates immediately after the 1998 elections. As a consequence, aggregate co-payments for pharmaceuticals decreased to €2 billion in 1999 and remained stable at €1.8 billion in the following years. The SHI Modernization Act of 2004 had a substantial impact on trends in the co-payments made by patients. Despite a marked reduction in the number of prescriptions in 2004, for example, aggregate co-payments increased to €2.4 billion. In the following years, however, this amount decreased again, reaching €1.7 billion in 2010; this resulted, in particular, from changes generated by the Act to Improve Efficiency in Pharmaceutical Care (Gesetz zur Verbesserung der Wirtschaftlichkeit in der Arzneimittelversorgung) of 2006, which allowed pharmaceuticals to be sold without a co-payment if their price was at least 30% lower than the reference price (see section 5.6.4).”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

“As a share of GDP, SHI [Statutory Health Insurance] expenditure on pharmaceuticals has gone sharply down (between 1992 and 1994), slowly up (until 1996), down again (in 1997), slowly but increasingly fast up (until 2003), and finally (in 2004) down again – because of new regulations on co-payments and the OTC [Over The Counter] exclusion from the SHI benefit basket under the SHI Modernization Act. However, since then, expenditure has increased again and in 2005 the SHI expenditure as a share of GDP already exceeded that in 2003. The decline from 1.17% in 2009 to 1.13% in 2010 is mainly attributable to the fact that the manufacturers rebate for prescription-only drugs and drugs without reference price was raised from 6% to 16% in mid-2010 (see section 5.6.4).”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

“The cornerstones of price regulation were barely changed between 1980 and 2003, but were substantially revised with effect from 2004. From 1980 to 2003, pharmacists and wholesalers were paid by digressively scaled margins as detailed in the Pharmaceutical Price Ordinance (Arzneimittelpreisverordnung). As the absolute size of the margin still increased with a product’s price, there was little incentive for a pharmacist to dispense a less expensive medicine. The margins for wholesalers and pharmacists were decreased in 2002. In 2004, the payment for pharmacists was substantially revised by the SHI [Statutory Health Insurance] Modernization Act (which in this respect also affected non-SHI-covered patients). This entailed the liberalization of OTC medication prices and a revision of the price-setting regulations for prescription-only drugs. The new “Pharmaceutical Price Ordinance for Prescription-only Pharmaceuticals” applies to the entire prescription-only market independent of the source of payment. It applies to human and animal drugs and to public pharmacies, but not to institutional pharmacies or to vaccines, blood replacement and dialysis-related drugs, for which sickness funds negotiate prices with manufacturers. Additionally, the competencies of sickness funds to negotiate volumes and prices for certain other drugs by circumventing pharmacies and/or wholesalers have been extended since 2004.

“For prescription-only drugs, pharmacists are now paid through a flat-rate payment of €8.35 plus a fixed margin of 3%. The retail price contains an additional 19% VAT [Value Added Tax] (16% before 2007). The margin of 3% is calculated from the manufacturer’s price plus the relevant maximum margin for wholesalers (excluding VAT).

“For non-prescription pharmaceuticals, pharmacies can freely determine the prices. Exempt from this rule are pharmaceuticals that, in principle, do not require a prescription but for which, for certain indications, physicians may issue prescriptions which will then be paid by the sickness fund. The Federal Joint Committee has published a list of these exceptions. For these, the Pharmaceutical Price Ordinance in the version of 31 December 2003 applies. Here, the defined percentage surcharge on the pharmacy cost price (i.e. manufacturer sales price plus wholesaler margin) valid up until 1 January 2004 continues to be charged.

“The abolition of price maintenance for non-prescription pharmaceuticals has not up to now led to a reduction in prices of non-prescription pharmaceuticals. Although price reductions have been observed for travel packages, some lifestyle pharmaceuticals and selected high-price pharmaceuticals (in competition with hospital pharmacies), the overall price level has not decreased as the abolition of fixed prices was also used for price increases.”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Dec. 23, 2020 by Doug McVay, Editor.