You might be familiar with the price negotiations to derive the reimbursement price, but this does not always reflect the final, real-world price paid by SHI funds in Germany. The final price is found in a step-wise process:
Free pricing
In Germany, free pricing applies in the first year. This means, at the time of launch in the German market, pharmaceutical companies 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 “Herstellerabgabepreis”.
Negotiated reimbursement price
After the G-BA published its final resolution on the additional benefit of the product, price negotiations between the pharmaceutical company and the GKV-SV, i.e., representatives of the SHI funds, will commence. These price negotiations are confidential. The negotiated reimbursement price is valid from month 7 after the day of launch going forward. Currently, the price is not applied retroactively from day 1. However, SHI funds regularly request this change in AMNOG law to save costs. The agreed reimbursement price is published in the Lauer Taxe as “Erstattungsbetrag”.
Individual contracts with SHI funds
In an additional step, the individual SHI funds can negotiate further rebates on the price directly with the manufacturers, according to § 130c SGB V. These contracts can be national or regional. These rebates 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.
Hospital contracts
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.
