German pharmacies face financial strain from soaring high-cost drug expenses

Pharmacies across Germany are struggling with financial pressure as high-cost medications become more common. These drugs now make up 40% of the sector's revenue, despite accounting for less than half a percent of all prescriptions. To ease cash flow problems, many owners are turning to advance payments on prescription reimbursements—though this solution comes with risks of its own.

Since 2010, sales of expensive medications in Germany have more than tripled. While they represent a tiny fraction of total prescriptions, their high prices force pharmacies to pay large sums upfront before receiving reimbursements—sometimes waiting up to four weeks. This delay has left many with dwindling cash reserves, pushing them to rely on early payouts just to cover routine expenses.

Several clearinghouses now offer advance financing to help pharmacies bridge the gap. The service allows owners to access reimbursement funds sooner, avoiding short-term financial distress. Yet, the fees charged for these advances can add to the strain, and over-reliance may worsen long-term instability. Regulatory changes have also tightened the squeeze. The 2024 BGH *Skonto* ruling (Az. I ZR 91/23) banned supplier discounts, raising procurement costs overnight. Meanwhile, new measures like § 40b (effective March 2024) and § 40c (from April 2026) permit pharmacies to substitute costly biologics with cheaper biosimilars—a move aimed at cutting expenses. The draft *ApoVWG* further seeks to adjust supply frameworks, but critics argue these steps may not be enough to offset the financial burden. More pharmacy owners are using advance payments, but the practice is no cure-all. Without deeper reforms, excessive dependence on early payouts could push some towards insolvency.

Advance payments provide temporary relief for pharmacies grappling with delayed reimbursements and high drug costs. However, the fees and risks tied to this financing mean it cannot solve the sector's deeper financial challenges. With regulatory adjustments still in progress, many pharmacies remain in a precarious position as they balance immediate needs against long-term stability.