OBJECTIVES: If price negotiations between pharmaceutical companies and the statutory health insurance funds in Germany fail, both parties usually end up before the AMNOG arbitration board. Disagreement usually exists about the reimbursement price. Although each arbitral award is a case-by-case decision, lessons can be derived from each decision. Thus, we aimed to identify recurring decision focal points concerning the reimbursement price which can utilize by companies for future successful negotiations in Germany.

METHODS: In our analysis of arbitral awards on reimbursement prices, we focused on identifying recurring influencing factors that were used by the arbitration board to set the price. Furthermore, we evaluated the impact of each factor concerning the final reimbursement price. We only considered decisions made since 2019 under the chairmanship of Prof. Stefan Huster.

RESULTS: Since 2019, 80.0% (16/20) arbitral awards have been issued on the reimbursement price: 35.0% (7/20) concerned drugs with additional benefit, 30% (6/20) referred to drugs without additional benefit, and 15.0% (3/20) related to drugs received more than one benefit assessment with various results. Only for drugs with considerable or major additional benefit, we were able to derive decision focal points on recurring influencing factors and their effect on the reimbursement price. We observed that the arbitration board weighted the monetization of the additional benefit at 50–90% in setting the reimbursement price, followed by the European prices, which were weighted at 5–30%, and costs of comparable drugs, which were weighted at 0–35%.

CONCLUSIONS: Currently, reimbursement prices are strongly limited by the legislator. However, for drugs with considerable or major additional benefit, the recurring influencing factors should be used in a targeted argumentative manner to increase the possibility for a higher reimbursement price. Thereby, the focus should be especially on the monetization of the additional benefit.