This page explains everything you need to know to identify and understand the different types of drug prices in Germany.
- Different definitions of drug prices in Germany
- Price discounts and rebates applied to drug prices in Germany
- So who is paying what?
- What does the manufacturer get in the end?
- Finding drug prices
- What is the Lauer Taxe?
- What can I find there?
- How can I access the Lauer Taxe?
- Registering a drug with Lauer Taxe
I have summarised everything you need to know about finding and understanding drug prices in Germany so you can quickly get up to speed on the intricacies of the German pricing system.
Different definitions of drug prices in Germany
Before we get into the details, it is important to understand the different definitions of prices. Thus, I have summarised the different types of prices in the following table:
| Price (English) | German terminology | Meaning |
|---|---|---|
| Ex-manufacturer price | Preis des pharmazeutischen Unternehmers (PpU) | = Manufacturer’s list price |
| Manufacturer sales price | Herstellerabgabepreis (APU/HAP) | = Price that manufacturer receives for the product In the first 12 months after launch, this matches the “PpU”, afterwards, it matches the “Erstattungsbetrag” |
| Reimbursement price | Erstattungsbetrag | = Maximum price reimbursed by SHI funds, before discounts |
| Pharmacy purchase price | Apotheken-Einkaufspreis | = Price that the pharmacy has to pay for the drug = Wholesaler sales price |
| Pharmacy sales price | Apotheken-Verkaufspreis | = Price that the pharmacy receives for selling the drug |
Price discounts and rebates applied to drug prices in Germany
Here is a short summary of the pricing system used to determine the reimbursement price for products with and without an additional benefit:
At the time of launch in the German market, manufacturers are free to set the price for their product with a new chemical entity (NCE). This price is then valid for the first 6 months from the day of launch. It is published in the Lauer Taxe as the ex-manufacturer price, i.e. the “Preis des pharmazeutischen Unternehmers (PpU)”.
At 12 months after launch, the reimbursement price was either negotiated, set through reference pricing or determined by the arbitration board (after 15 months). This reimbursement price is retroactively applied from month 7 after launch onwards. The Lauer Taxe includes this reimbursement price as “Erstattungsbetrag”.
This reimbursement price is the highest price that the SHI funds would pay, but often further discounts are applied to derive the final, real-world price paid by wholesalers, pharmacies, patients and SHI funds in Germany.
Mandatory discounts benefitting SHI funds
Mandatory discounts given by manufacturers (German: “Herstellerabschlag”)
Outside of reference price groups, manufacturers have to grant SHI funds a mandatory discount on their ex-manufacturer price. These discounts are dictated by § 130a SGB V. They differ depending on the type of product:
- With patent protection: 7% (12% in 2023)
- Without patent protection: 6%
- Within a reference price group, priced below reference price: no discount
Mandatory discount for generics
In addition, there is a mandatory discount of 10% for generics and their reference drugs. These discounts are additive, so a generic drug (which will have no patent protection) requires a discount of 16% (=6% + 10%).
However, if the price of the generic is at least 30% below the reference price, the product is exempt from the mandatory 10% discount for generics.
Mandatory discounts given by pharmacies (German: “Apothekenabschlag”)
Pharmacies have to grant the SHI funds a mandatory discount of €2.00 per product for so-called “finished drugs” (German: “Fertigarzneimittel”), i.e. those that can be sold as they come and don’t need to be prepared by a pharmacist.
The discount for products within reference price groups is based on the reference price. If the ex-manufacturer price lies below the reference price, the discount is based on the lower price.
Additional discounts for individual SHI funds
In an additional step, the individual SHI funds can negotiate further discounts on the price directly with the manufacturers, according to § 130c SGB V. These contracts can be national or regional. These discounts can be in the form of staggered price-volume agreements, maximum annual sale volumes, or pay-for-performance agreements. Bigger SHI funds have greater negotiation power and therefore might achieve higher discounts. These contracts are confidential.
The discounts can also be passed through to the insured patients and thus may result in patients not having to cover co-payments.
Hospital contracts
Furthermore, hospitals are negotiating drug prices directly with the manufacturers. The reimbursement price set in the negotiations with the GKV-SV reflects the maximum price for these contracts. Again, bigger hospitals are more influential in negotiations and may achieve higher discounts compared with smaller ones. These hospital contracts are also confidential, and the amount of discount is not publicly known.
So who is paying what?
Wholesalers
Wholesalers are buying the product from the manufacturer. They pay the manufacturer sales price. Then, they sell the product again to the pharmacies.
To cover their costs, the wholesalers add a surcharge (German: “Zuschlag”) to their purchase price for finished drugs. The government sets the amount of the surcharge. This is regulated in the Arzneimittelpreisverordnung (AMPreisV, Drug Price Ordinance).
Currently (in 2024), the cap for the surcharge is a maximum of 3.15% of the manufacturer sales price per package (maximum of €37.80). On top of this, wholesalers add a fixed fee of €0.73 to the surcharge to remunerate the procurement, storage and distribution of the products.
Pharmacy
Likewise, pharmacies are paying the pharmacy purchase price to buy the product from wholesalers and then sell it again for the pharmacy sales price.
The pharmacy sales price is higher than the pharmacy purchase price. The difference or surcharge covers the service provided by the pharmacy. Again, the amount of it is determined by the government, as set out in the Arzneimittelpreisverordnung (AMPreisV, Drug Price Ordinance). The pharmacy surcharge differs between finished drugs and those that need to be prepared and dispensed by the pharmacies:
Finished drugs
Currently (in 2024), pharmacies are allowed to add 3% of the purchase price. Furthermore, they then add a fixed fee of €8.35 per package. On top of this, there is a fee of €0.21 to support their provision of emergency services plus €0.20 to finance additional pharmaceutical services (since 15 Dec 2021).
Dispended drugs
The surcharge for dispensed drugs has three parts: The pharmacies add 90% of the pharmacy purchase price, a dispensing surcharge fee of €3.50 to €8.00, and again the fixed fee of €8.35 per package. The dispensing surcharge fee depends on the amount and type of substances within the dispensed drug.
Lastly, VAT of 19% applies to pharmacy drugs.
Since all the surcharge components are dictated by the law, the pharmacy sales price of a prescription drug is the same across all pharmacies in Germany.
Patients
The treating physician can prescribe a drug for a patient. The patient then takes this prescription to the pharmacy to receive the drug. While the SHI funds cover the majority of the costs, the patient still has to pay a co-payment of 10% of the pharmacy sales price, at least €5, to a maximum of €10 or the total sales price.
Exception:
Products in a reference price group that are priced at least 30% below the reference price can be exempt from the patient co-payment.
SHI funds
The SHI funds cover the pharmacy sales price MINUS
- the patient co-payment
- the mandatory discounts given by the manufacturer and the pharmacies (see above)
- any additional optional discounts through individual contracts.
These prices are capped for products outside of reference price groups (German: “Preismoratorium”). That means that SHI funds will not pay more even if manufacturers increase their prices. This price moratorium is currently in place until the end of 2026. Given it has been in place for many, many years, an extension after 2026 is also likely.
Example calculation of the final drug prices in Germany
Let’s bring this all to life by going through an example calculation of the prices for both a finished and a dispensed drug.
| Finished drug, with patent protection | Dispensed drug | |
|---|---|---|
| Manufacturer sales price (= Ex-manufacturer price or reimbursement price) | €50.00 | |
| + wholesaler surcharge (3.15% plus €0.73) | + €2.31 | |
| = Pharmacy purchase price | = €52.31 | €5.00 |
| + pharmacy surcharge (3% plus €8.35 for finished drugs; 90% plus €8.35 for dispensed drugs) | + €9.92 | + €12.85 |
| + fee for the provision of emergency services | + €0.21 | |
| + fee to finance additional pharmaceutical services | + €0.20 | |
| + dispensing surcharge fee (€3.50 to €8.00) | + €6.00 | |
| = Net pharmacy sales price | = €62.64 | = €23.85 |
| + 19% VAT | + €11.90 | + €4.53 |
| = Pharmacy sales price | = €74.54 | = €28.38 |
| – Patient co-payment (10%) | – €7.45 | – €5.00 |
| – Mandatory pharmacy discount (€2.00) | – €2.00 | – €2.00 |
| – Mandatory manufacturer discount (7% of manufacturer sales price [12% in 2023]) | – €3.50 | |
| = Price paid by SHI funds (additional discounts are possible) | = €61.59 | = €21.38 |
References:
- https://www.bundesgesundheitsministerium.de/arzneimittelpreise.html
- https://www.abda.de/apotheke-in-deutschland/preise-und-honorare/beispielrechnung/
- https://www.gesetze-im-internet.de/ampreisv/BJNR021470980.html
What does the manufacturer get in the end?
In summary, after all these surcharges, discounts and rebates, how much of the price is actually received by the manufacturer in the end?
The manufacturer will receive
- the manufacturer sales price, which matches the ex-manufacturer price for the first 6 months and then the reimbursement price thereafter
- minus the mandatory manufacturer discount
- minus any additional discounts agreed with individual SHI funds or hospitals.
Therefore, the manufacturer receives 93% of the manufacturer sale price for a product with patent protection, before any optional agreements.
Finding drug prices
What is the Lauer Taxe?
The Lauer Taxe is a database of all pharmaceuticals approved on the German market.
It includes all pharmaceutical entities, e.g. drugs, medical devices and also remedies, and probably most importantly, also their prices. For any active ingredient, it covers originators and biosimilars or generics, if applicable.
The database was first developed in 1950 by Josef Lauer when it obviously was entirely paper-based and sorted in physical folders. It originally covered mainly the ABDA data for all included pharmaceuticals. These include all the information required for the dispensing and billing of drugs. In addition to price information, the Lauer Taxe shows pharmaceutical legal information and other pack-related data.
The intended main users of the database are pharmacists and wholesalers, as the Lauer Taxe is a useful reference and ERP system to order pharmaceutical products. However, nowadays the pharmaceutical industry and consultancies as well as the SHI funds all also use the Lauer Taxe to access prices of potential comparators or competitors in Germany.
The Lauer Taxe is updated twice a month, always on the 1. and 15. of every month.
What can I find there?
The key information for each article is:
- Pharmaceutical central number (PZN)
- Article description
- Pack size and packing unit; therapy-appropriate / economical pack sizes (N-label); alternative quantities
- Legal information
- Dosage form
- ABDATA code for analysis and research
- Manufacturer sales price, pharmacy purchase and pharmacy sales price, RRP (recommended retail price), VAT rate, Reference price and co-payment information; Manufacturer discounts
- Regulations on prescriptions or OTC, etc.)
- References to the drug directive
- Detailed seller information
- Storage instructions, storage duration
- Pharmaceutical stock in accordance with § 15 ApBetrO
- Wholesalers with postal, e-mail and internet addresses as well as telephone and fax numbers in certain areas: z. B. Order acceptance, medical-scientific information (service lines)
The most important for us is probably the price data. On the price tab for a product (German: “Preis-Info”), you can find all different price definitions, alongside values of discounts and rebates.
The prices include the ex-manufacturer price, any mandatory rebates, the reference group price or the negotiated reimbursement price. Additionally, one can also find information on discount agreements and product characteristics, e.g. dispensing regulations or side effects and interactions.
Example of price data displayed in the Lauer Taxe
The picture above shows an example entry for the drug Jevtana. The most relevant entries are:
Header section
Here, we can find the price for 60 mg of the infusion solution. The Taxe-EK shows the pharmacy purchase price, and the Taxe-VK shows the pharmacy sales price.
Basis data (box in top left)
This box displays the manufacturer sales price (APU / HAP), and again the pharmacy sales and purchase prices.
In addition, it also shows the amount of VAT (German: “Mehrwertsteuer”), here 19%.
And lastly, we can find the data of the latest changes to this price. In this example, it is the 1st April 2014.
The G-BA has assessed Jevtana in an early benefit assessment. You can see from the Yes (“Ja”) under “Frühe Nutzenbewertung nach §35a SGB V (see below).
- As a result of this early benefit assessment for Jevtana, a reimbursement price was determined. This price is shown under “Erstattungsbetrag” (see below), and matches the manufacturer sales price.
- On the other hand, if a reference price would apply to this drug, then the “Festbetrag” shows this price.
Discounts for SHI funds
In the middle box on the left called “Krankenkassenrabatt”, we can find the mandatory discounts by the pharmacy (“Pflichtrabatt der Apotheke”) and by the manufacturer (“Pflichtrabatt des pharmazeutischen Unternehmers”). This box also shows whether the manufacturer made any additional agreements with the SHI funds (“Ja”). You can find the details of these by clicking on the ellipsis symbol.
List prices / Reimbursement price
The last box on the left displays the ex-manufacturer or list price (“Preis des pharmazeutischen Unternehmers (PpU)”), as well as the reimbursement price (“Erstattungsbetrag”).
Patient co-payments
The top right box called “Patientenanteile” shows the amount of any patient co-payment under “Zuzahlung”.
Reimbursement conditions for SHI funds
And lastly, the Lauer Taxe also notes any special reimbursement conditions. It shows, for example, if the drug
- is an OTC drug or lifestyle drug
- belongs to the negative list
- has any reimbursement restrictions or exclusions.
As mentioned above, we can see whether the drug has gone through an early benefit assessment.(Yes (“Ja”) under “Frühe Nutzenbewertung nach §35a SGB V).
Reference: https://webapo-info.lauer-fischer.de/
How can I access the Lauer Taxe?
The Lauer Taxe and similar databases are very popular and sought after by consultancies and pharmaceutical companies since the information is publicly available. This means anyone can find list prices and mandatory discounts of potential comparators or competitors in Germany.
The providers of the Lauer Taxe, CompuGroup Medical, charge an annual fee for online access depending on the number of users. The current price points are not disclosed. However, in previous years, an annual license for one user cost around €5,500.00.
A license can be requested here: https://www.cgm.com/deu_de/produkte/apotheke/lauer-taxe-en.html
Registering a drug with Lauer Taxe
The underlying database of the Lauer Taxe is the IFA database. This database covers information for drugs, including OTC and lifestyle drugs, medical devices and also remedies etc. In order for Lauer Taxe to list the information, the manufacturer or wholesaler has to submit the following information to the IFA:
- regulatory information, including the SPC
- completed form (Appendix B1 for drugs, Appendix B3 for medical devices) which details prices, packages sizes, storage information etc. This also includes legal information, such as whether it is an ATMP, orphan drug, a prescription or OTC drug, or a lifestyle drug, etc.
The IFA registration is considerably cheap. In 2024, there is an annual fee of €75.00 to register the manufacturer. Then, there is a charge of €7.00 for every new product. Changing information for a registered product costs €3.50.
The Lauer Taxe is updated twice a month, on 1. and 15. This ensures that it always reflects the latest information from the IFA database.
Reference: https://www.ifaffm.de/