Fixed amount

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In the German health system, the fixed amount is the maximum limit up to which the statutory health insurance funds pay for certain drugs and aids .

Fixed amounts were first introduced for drugs and aids when the Health Reform Act (GRG) came into force in 1989. The legal basis for the fixed amounts can be found in § 35 , § 35a , § 35b and § 36 Fifth Book of the Social Code (SGB V). The difference between the fixed amount set by the central associations of the health insurance companies (according to § 35 and § 36 SGB ​​V) or the Federal Ministry of Health (according to § 35a SGB ​​V) and the possibly higher sales price of the drug or aid is borne by the patient himself.

Since January 1, 2004, fixed amounts can also be set for patented medicinal products under certain conditions. The following applies here:

  • The formation of a fixed price group with patented drugs is only possible if there are at least three drugs in this group.
  • It is possible to form a mixed group of medicinal substances whose patent has already expired and medicinal substances that are still patented ("jumbo group").
  • No patent-protected active ingredients may be included that would improve the therapy or e.g. B. mean reduced side effects ( Section 35 (1a) SGB V).

Since January 1, 2005, nationwide uniform fixed amounts can be set for individual seven-digit items in the list of medical aids . These replace the nationwide fixed amounts that were valid until then.

Fixed amounts have currently been set in the following product groups:

The determination of fixed amounts takes place in two stages. First of all, the Federal Joint Committee defines the groups of medicinal products that can be combined from their point of view. Information from the drug commission of the German medical profession is used here, and in future also from the Institute for Quality and Efficiency in Health Care . Furthermore, experts from medical and pharmaceutical science and practice as well as pharmaceutical manufacturers and pharmacists' representatives have hearing rights. The fixed amounts are then set by the National Association of Health Insurance Funds ( GKV-Spitzenverband ).

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Wiktionary: Fixed amount  - explanations of meanings, word origins, synonyms, translations