German health funds back pharmacy reforms but warn of rising costs

The Association of Substitute Health Funds (vdek) has given a mixed response to the proposed Pharmacy Supply Development Act (ApoVWG). While backing key reforms, the group has raised concerns about rising costs and regulatory overreach. Their stance highlights both support for improved services and warnings about financial strain on statutory health insurance (GKV).

The vdek has welcomed several aspects of the reform. They approve of structural changes, such as higher allowances for night and emergency pharmacy services. Funding for these increases could come from the €540 million in unused reserves from the Fund for Pharmaceutical Services (pDL). The group also supports subsidies for partial emergency services and a self-governance model for negotiating remuneration.

However, the association strongly opposes measures that could drive up costs. They argue that expanding pharmacists' discretion to deviate from cost-effective drug selection will push GKV expenses higher. The vdek also rejects legally binding definitions of pDL measures, warning this would weaken healthcare self-governance.

On patient access, the vdek sees the option to dispense prescription-only medications without a doctor's order as a practical improvement. Yet they criticise the removal of zero-price retroactive adjustments, claiming it undermines economic supply rules. Existing framework agreements, they insist, already provide enough flexibility to secure drug availability without further substitution options.

Current emergency service payments stand at €550 per call under the GKV since 2013. But the vdek has not released daily or monthly expenditure figures for these services before the reform.

The vdek's position balances approval of service improvements with warnings about financial risks. They back higher emergency allowances and pragmatic dispensing rules but fear broader discretion for pharmacies will inflate costs. Their call for clearer spending controls reflects concerns over the long-term impact on GKV budgets.