If the G-BA concludes its early benefit assessment with “No additional benefit (proven)” and the product falls into a reference price group, then its reimbursement price is determined by the reference pricing system instead of negotiation.
If this drug cannot be assigned to a reference price group, the reimbursement price will still be negotiated. In this case, the negotiated price will be set so that the annual therapy costs are not higher than those for the appropriate comparator therapy.
The reference price dictates the maximum price that SHI funds will pay for drugs within a reference price group.
The G-BA determines the reference price group that a product falls in. If the manufacturer of one such drug does not reduce its price to the reference group price, then the price difference has to be covered by patients themselves. Alternatively, physicians could prescribe a different drug within the same reference group or another drug covered by SHI funds.