German health funds clash over pharmacy reform costs and emergency care funding

The Association of Substitute Health Funds (vdek) has weighed in on the proposed Pharmacy Supply Development Act (ApoVWG), backing some reforms while raising concerns over rising costs. The group supports changes to emergency service funding but strongly opposes new rules giving pharmacists more flexibility in drug selection.

One key proposal involves using nearly €540 million in unused reserves from the Fund for Pharmaceutical Services (pDL) to finance emergency care. The vdek argues this would help stabilise funding without adding extra financial pressure.

The vdek has welcomed several aspects of the reform. It approves of the planned increase in night and emergency service allowances, which will rise to €9.50 per case, leading to an estimated €875 million in additional annual costs. The group also supports subsidies for partial emergency services and a new self-governance model for negotiating remuneration. However, it has asked for clearer safeguards to prevent excessive spending increases within the statutory health insurance system (GKV).

At the same time, the association has criticised parts of the legislation. It opposes the expansion of pharmacists' discretion to substitute prescribed drugs, calling the move unnecessary and likely to drive up costs. The vdek also warns that scrapping zero-price retroactive adjustments could weaken cost-efficiency checks and disrupt rebate settlements.

To avoid further financial strain, the vdek has proposed dissolving the pDL entirely. It argues that the fund's unused reserves—estimated between €540 and €600 million—could instead be redirected to secure emergency service allowances. Without this step, the group believes the reform will push up GKV expenses, mainly due to broader substitution rules and the fund's expansion.

The vdek's stance highlights a mix of approval and concern over the pharmacy reform. While it backs structural changes and higher emergency service payments, it warns that some measures could lead to uncontrolled cost increases. The group's proposal to repurpose unused pDL funds aims to balance improved services with financial stability for the health insurance system.