OBJECTIVES: Since 2005 the NUB program has been available in the German in-patient sector for introduction of innovative medical technologies. It allows providers to apply for funding in early market phases, after submitting an application for the respective method and appraisal by an independent institute (InEK). Ultimate goal of the process should be transfer into the regular DRG system. Aim of this study was to evaluate the rate of successful transfer of NUB methods into the regular DRG system and investigate patterns of transfer.

METHODS: NUB applications of the years 2005-2018 were obtained from the InEK database (www.g-drg.de). Data was analyzed according to time from application to integration, number of applying hospitals and final integration route.

RESULTS: Since 2005, NUB applications for 3110 medical methods were submitted. Out of these, 78 interventions were transferred in the regular DRG catalogue (54 pharmaceuticals, 20 medical devices, 3 surgical procedures, 1 diagnostic). The majority (96.15%) had been classified NUB status 1 before transfer. Mean time between initial application and inclusion was 38.7 ± 22.2 months. Successfully integrated methods had on average 522.6 ± 485.6 hospital applications. Pharmaceuticals had significantly more applications than medical devices (634.88 ± 482.25 vs. 211.87 ± 287.84 applying hospitals, p < 0.005) and transfer time was significantly longer (40.70 ± 20.86 vs. 24.45 ± 20.88 months, p < 0.05). Most methods were integrated as an add-on fee (88.46%), while the rest received a DRG code.

CONCLUSIONS: Though the NUB program was introduced to enable market entry for innovations, the permeability of the DRG system is low and rarely leads to long-term funding. Innovators should investigate alternate pathways for sustainable reimbursement. Even among methods with highest status, only 20.66% are transferred into regular reimbursement (75/363). Further investigation is required to improve understanding on the role of demand and therapy diffusion in the transfer process.