The New Discount on Combination Drug Therapies in Germany: First Numbers and Assessment From a Payor Perspective
Author(s)
Antje Mevius1, Barthold Deiters, PhD2, Thomas Wilke, PhD3, Mareike Klein, Mrs4, Sabrina Müller, MSc5.
1Research Principal, IPAM e.V., Wismar, Germany, 2GWQ ServicePlus AG, Düsseldorf, Germany, 3IPAM e.V., Wismar, Germany, 4GWQ Serviceplus AG, Düsseldorf, Germany, 5GIPAM GmbH, Wismar, Germany.
1Research Principal, IPAM e.V., Wismar, Germany, 2GWQ ServicePlus AG, Düsseldorf, Germany, 3IPAM e.V., Wismar, Germany, 4GWQ Serviceplus AG, Düsseldorf, Germany, 5GIPAM GmbH, Wismar, Germany.
OBJECTIVES: From October 2023 onwards, German (GER) statutory health insurance funds (SHIs) are entitled to a discount of 20 percent of the manufacturers’ prices on outpatient drugs that are prescribed in a combination with another drug as designated by the Gemeinsamer Bundesausschuss” (G-BA). The GER government expected medium-term savings of approximately €185 million per year. The objective of this project was to generate the first numbers on this new discount scheme.
METHODS: For the descriptive analysis of overall numbers on drug spending and combination discounts, claims data from GWQ Service Plus (covering SHIs insuring 8.68 mio. persons as of 01.01.2024, i.e. 11,7 % of the GER SHI population) were used.
RESULTS: As of October 2023, the G-BA defined more than 200 combinations to be eligible for the new discount scheme. Due to different reasons such as late market entries or early market exits, only 157 of these combinations (Q4 2023) / 136 combinations (Q1 2024) qualified for the discount. In this period, above combinations generated €22 mio. outpatient drug spendings; the resulting discount was therefore €4.4 mio. In a projection based on GER SHIs expenses of €55 billion EUR on outpatient drugs, this would translate into a yearly discount volume of about 75.4 mio. € (0,14% of overall drug spending).
CONCLUSIONS: The expected drug cost savings associated with the new GER combination discount are substantially lower than expected. The main reasons for that are restrictive definitions of the term “combination therapy” and a very restrictive list of relevant combinations as defined by the G-BA, focusing on “on label” combination therapies that did not achieve a substantial benefit in a previous G-BA assessment. Substantially higher savings addressing combination prescriptions would only be achievable if off-label combination prescriptions within certain disease areas are included in the scheme.
METHODS: For the descriptive analysis of overall numbers on drug spending and combination discounts, claims data from GWQ Service Plus (covering SHIs insuring 8.68 mio. persons as of 01.01.2024, i.e. 11,7 % of the GER SHI population) were used.
RESULTS: As of October 2023, the G-BA defined more than 200 combinations to be eligible for the new discount scheme. Due to different reasons such as late market entries or early market exits, only 157 of these combinations (Q4 2023) / 136 combinations (Q1 2024) qualified for the discount. In this period, above combinations generated €22 mio. outpatient drug spendings; the resulting discount was therefore €4.4 mio. In a projection based on GER SHIs expenses of €55 billion EUR on outpatient drugs, this would translate into a yearly discount volume of about 75.4 mio. € (0,14% of overall drug spending).
CONCLUSIONS: The expected drug cost savings associated with the new GER combination discount are substantially lower than expected. The main reasons for that are restrictive definitions of the term “combination therapy” and a very restrictive list of relevant combinations as defined by the G-BA, focusing on “on label” combination therapies that did not achieve a substantial benefit in a previous G-BA assessment. Substantially higher savings addressing combination prescriptions would only be achievable if off-label combination prescriptions within certain disease areas are included in the scheme.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
HPR210
Topic
Health Policy & Regulatory
Topic Subcategory
Public Spending & National Health Expenditures
Disease
No Additional Disease & Conditions/Specialized Treatment Areas