Prescription fee

The prescription fee is an additional payment that must be paid by the patient for medication on prescription . It represents a form of the fixed deductible (deductible) . The prescription fee is generally paid in the pharmacy that dispenses the medication .

Situation in German-speaking countries

Germany

The prescription fee in Germany is  charged in favor of the statutory health insurance (GKV). For every prescription drug, the patient has to pay 10 percent of the sales price (even if several drugs are noted on a prescription).

The fee is collected by the health insurance company through the pharmacy and 100 percent goes to the respective health insurance company.

Until 2003 and when the Statutory Health Insurance Modernization Act came into force , the so-called prescription fee was based on the size of the pack.

The Statutory Health Insurance Modernization Act, which came into force on January 1, 2004, set the prescription fee at 10 percent of the drug sales price and thus increased it for many drugs. The prescription fee is limited to a minimum of 5  euros and a maximum of 10 euros.

Exceptions are:

• The selling price of the drug in the pharmacy is less than 5 euros. So only the selling price that is relevant for the patient has to be paid. However , this is impossible for prescription drugs because the new drug price regulation that came into force on January 1, 2004 calculated the sales price as follows: pharmacy purchase price (net) + 3% + 8.35 euros + sales tax

• The additional payment for a drug can then be higher than the actual prescription fee if the doctor prescribes a drug that is higher than the fixed amount reimbursed by the health insurers . If the doctor prescribes a drug that is more expensive than the fixed amount, the patient must pay the statutory additional payment and the difference to the fixed amount at the pharmacy. This difference is also known as the patient share (Pa).

• “Children under the age of 18 are exempt from all additional pharmaceutical payments. For children under the age of 12 and adolescents with developmental disorders up to the age of 18, non-prescription drugs can usually be paid for by the health insurance company. "

In particular cases of hardship and chronic illnesses, however, it is possible to be exempt from the prescription fee.

If the costs of medical treatment after a work or school accident are covered by the statutory accident insurance, the insured person does not have to pay a prescription fee for drugs and remedies to the statutory health insurance either.

In 2012, according to the German Pharmacy Association (DAV), each patient paid an average of EUR 2.60 per drug pack.

Austria

Financial flows in the Austrian healthcare system

Bonuses

→

Private insurance

Special services

Catalog services ( after DRG )

Contributions

→

Health insurance ( compulsory insurance)

Taxes

FA →

→

BM (Fin)

countries

→

BGA

Art. 15a BV-G

↓

budget

←

Country Fund ( LGF)

→

→

↓

population

Deductibles

Fund KA

←

AN , AG

(←)

→

←

fee

←

Private KA

some deductibles *

←

PRIKRAF

←

Expense coverage

or.

(←)

→

Outpatient clinic

←

some deductibles *

Flat rate +  individual services

(←)

→

(practicing) doctor

←

Exp. f. Drugs +  of pharmacy services

Prescription fee **

patient

(←)

→

pharmacy

←

↑

reimbursement

(Fin) Ministry of Finance distributes the budget for the Ministry of Health ; * flows directly to KV carriers; ** flows via pharmacy to health insurance providers; (←) partly direct reimbursement or exemption for mandatory verse. Reds: Government Sector, Yellows: Private Sector Diagram according to Ziniel (2005)

In Austria, insured persons with statutory health insurances (compulsory insurance) pay a prescription fee for medication that is prescribed on a prescription if they are not exempt from the prescription fee. It is collected by the pharmacy and offset against the health insurer (the pharmacies are reimbursed for the expenses for medication and pharmacy services from the health insurers ).

Regardless of the actual price of the drug, the prescription fee is 6.30 euros (as of January 3, 2020) per drug pack. However, if the full price of the pack is less than the prescription fee, only this is to be paid.

The prescription fees were introduced in Austria in 1956 (at that time 2  schillings ).

Exemptions from the prescription fee:

• On January 1, 2008, a prescription fee limit of 2% of the patient's annual net income was introduced. This means that within a calendar year, the prescription fee only has to be paid until the total amount of the fees paid has reached 2% of the annual net income. From this point on, the patient is automatically exempt from the prescription fee for the rest of the year. At the same time, however, there is a minimum limit of 38 prescription fees, which must be paid in any case per year (around 1 per 10 days). As a result, this form of liberation mainly benefits people who are on long-term medication. Co-insured relatives are included. For this purpose, the Main Association of Austrian Social Insurance Institutions creates a prescription fee account for all insured persons . It is managed electronically and billed via the e-card . The prescription fee account can be viewed online by every insured person (registration with citizen card or mobile phone signature ).
• Certain groups are generally exempt from the prescription fee, such as people with notifiable communicable diseases , civil servants and participants in voluntary services , war victims .
• An exemption from the prescription fee is also granted under certain conditions of special social protection, for example when receiving a compensation allowance.

Web links

Wiktionary: Prescription fee  - explanations of meanings, word origins, synonyms, translations

Individual evidence

1. ↑ [1]
2. ↑ [2]
3. ↑ Reproduced in: Ch. Herber; J. Weidenholzer (Ed.): Assessment approach of the implementation of the health reform 2005 . Linz 2007, p. 133 (PDF, ooegkk.at, accessed on July 20, 2014) - there “Ziniel (2005)” without further details.
4. ↑ ^{a b} HELP.gv.at: Prescription fees.
5. ↑ Prescription fee , Austrian Chamber of Pharmacists, apotheker.or.at
6. ↑ ^{a b} Prescription fee / exemption from prescription fees ( Memento of the original from August 11, 2014 in the Internet Archive ) Info: The  archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Website of the NÖGKK - with a computer online guide ( memento of the original from August 11, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. 
7. ↑ Prescription fees. Retrieved January 3, 2020 . 
8. ^ Prescription fees 1956 - 2014 , apotheker.or.at
9. ↑ ^{a b} Upper limit for prescription fees ( Memento of the original from July 29, 2014 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , Sozialversicherung.at (also in several languages ​​including sign language).  
10. ↑ Prescription fee account ( Memento of the original from July 28, 2014 in the Internet Archive ) Info: The  archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. login , on Sozialversicherung.at (website of the Main Association of Austrian Social Insurance Institutions, https)
11. ↑ ^{a b} and the service fee for the e-card
12. ↑ ^{a b} Exemption from prescription fees , Sozialversicherung.at