Aut idem

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The term aut idem is a medical-pharmaceutical term that comes from Latin and literally means "or the same". By adding the words “aut idem” to a prescription , a doctor allows the pharmacist to dispense a different drug than the one prescribed by name but with the same active ingredient.

concept

Originally, the prescription supplement was used to ensure the rapid supply of a patient with medication, even if the pharmacy did not have the medication named in the prescription in stock. Today, however, replacing the prescribed agent with a cheaper agent with the same active ingredient is often used to achieve savings in the pharmaceutical sector.

Implementation in Germany

Sample 16: Form for drug prescriptions (German health insurance prescription)

In the German health care system , pharmacists are obliged, according to Section 129, Book V of the Social Code (SGB V) , to dispense a discount drug in the case of an aut-idem regulation . This promises savings in the pharmaceutical sector. Aut-idem fields are pre-printed on today's prescription forms (sample 16) that are required for billing with statutory health insurances , which the doctor must tick if he does not allow the drug to be replaced ("Nec aut idem"). An aut-idem field that is left unchanged automatically has the meaning "aut idem". Originally, the box had to be ticked if the exchange was to be allowed . However, since this was hardly used by the doctors, but the exchange was politically wanted because of the savings hoped for, a change in meaning was decreed in 2002; the exchange is now excluded if the box is ticked.

The pharmacist must dispense a drug that corresponds to the originally prescribed drug in terms of active ingredient, active ingredient strength, pack size and (at least) one indication and has an identical or "comparable" dosage form .

Obligations of the pharmacy

  • If the doctor has to replace not exclude a drug after the aut idem regulation (the aut idem Cross therefore not set), it must be determined whether the insured person's fund for that product or one that meets the above exchange criteria , has concluded a discount agreement . If so, a contractual medicinal product must be dispensed.
  • If there are no discount agreements or if the contractual drugs are not available, the pharmacist can choose between the drug prescribed by name and the three cheapest drugs that meet the aut-idem exchange criteria.
  • For certain drugs, the exchange according to the aut-idem regulation is not permitted; only the drug prescribed by name must then be dispensed, regardless of whether the doctor has ticked the box or not.

Problems and Consequences

  • Since the decision as to which generic product is to be sold by which manufacturer is no longer entirely made in the pharmacy, delivery bottlenecks due to manufacturers who can not deliver or waiting times due to orders from the pharmacy cannot always be ruled out.
  • Patients on long-term medication can now receive medication in different packs more often. Fears that the other drug might not work in the same way as the previous one, worsen compliance and can lead to nocebo effects .
  • The drugs to be exchanged may differ slightly, but this can be decisive in the specific individual case. The exchange preparations may not be divisible, so that the patient cannot generate the individually required dose.
  • In the case of preparations with a narrow therapeutic range and sensitive absorption (active ingredients with critical doses, e.g. thyroid hormones , immunosuppressants , cardiac glycosides and phenprocoumon ), even slight differences in bioavailability can lead to dangerous dosing problems. For some active ingredients or their dosage forms specified by the Federal Joint Committee in the so-called substitution exclusion list, there is now an exchange ban.
  • Especially in elderly patients who have to take numerous drugs at the same time, frequently changing names and presentations of the preparation can lead to mix-ups and incorrect medications.
  • If there is a discount agreement between the health insurance company and a manufacturer, it is possible that the insured person will still have to make the legally prescribed co-payment, even though the drug from other manufacturers is listed on the list of drugs exempt from co-payment.
  • Originally it was stipulated that the drug dispensed had to have all the indications that the originally prescribed drug would have had. It is now sufficient if one indication matches; however, this does not have to be the case for the specific patient. As a result, the patient may not find the information and instructions for use that apply to his illness in the package insert.
  • The use of drugs defined as interchangeable can sometimes differ significantly. This is the case, for example, with powder inhalers. The different inhalation systems require different handling, and depending on the severity of the respiratory disease, an exchange preparation can be completely useless for the patient, as he or she cannot apply the required suction force.

Situation in Austria

As part of the health reform to relieve the health insurance companies, the introduction of an "aut-idem rule" is being discussed, which obliges the doctor to prescribe an active ingredient ; only in justified exceptional cases may he insist on a specific preparation. This regulation would affect the approx. 200 drugs that are classified as generic-capable in Austria.

See also

Individual evidence

  1. ↑ Aut idem. Retrieved February 15, 2019 .
  2. ↑ Fig. Of the recipe form sample 16
  3. ^ Aut-idem regulation of the KBV
  4. ↑ http://www.aerzteblatt.de/pdf/109/26/m459.pdf Häuser W, Hansen E, Enck P: Nocebo phenomena in medicine: their relevance in everyday clinical practice. Dtsch Arztebl Int 2012; 109 (26): 459-65. doi : 10.3238 / arztebl.2012.0459