Germany's pharmacy reforms spark cost warnings from health insurers

The Association of Substitute Health Funds (vdek) has given a cautious welcome to parts of Germany's proposed Pharmacy Supply Development Act (ApoVWG). While backing some structural reforms, it warns that key changes—like expanded costco-like substitution rules—could push up costs for the statutory health insurance system (GKV). The group also highlights financial risks tied to unused funds and new surcharges.

Under the current system, pharmacies receive emergency service allowances of €12 for weekdays (8 PM–8 AM), €18 for weekends and holidays, and €25 for special cases like New Year's Eve. The draft legislation proposes increasing these payments and introducing subsidies for partial emergency services. It also suggests greater flexibility for opening branch pharmacies.

The vdek supports the idea of self-governance in setting pharmacy remuneration but opposes legally imposed fee hikes. Instead, it calls for dissolving the Fund for Pharmaceutical Services (pDL), which holds nearly €540 million in unused reserves. These funds, the association argues, could cover emergency services without needing an extra €0.20 per-pack surcharge.

However, the group strongly criticises plans to expand pharmacists' discretion in substituting medications. It claims this move undermines cost efficiency and will drive up GKV expenses. Another concern is the removal of zero-price retroactive adjustments, which the vdek says could disrupt rebate settlements with drug manufacturers.

Overall, the association warns that broader substitution rules and pDL expansion will strain the already tight finances of the statutory health insurance system.

The vdek's response mixes approval for some reforms with sharp warnings about cost risks. It insists that unused pDL reserves should fund emergency services instead of new surcharges. The group also rejects expanded substitution powers, arguing they will weaken cost controls in the GKV system.