Therapy advice of the Federal Joint Committee
The Federal Joint Committee (G-BA) defines therapy instructions for the area of application of individual active ingredients in the drug guidelines in order to substantiate the economic efficiency requirement of therapies within the framework of statutory health insurance (GKV).
With the guidelines, the G-BA determines the catalog of services for the statutory health insurance and thus determines which medical care services - here: which drugs - are reimbursed by the statutory health insurance. The background to the guidelines is Section 12 (1) of the fifth book of the Social Security Code , which regulates: "The benefits must be sufficient, appropriate and economical; they must not exceed what is necessary. Benefits that are unnecessary or uneconomical cannot be provided by the insured claim, the service providers are not allowed to effect and the health insurances not approve. "
The therapeutic advice relates in particular to relatively new and high-priced drugs. They provide information about the scope of the approval as well as about the effects, effectiveness and risks. They give recommendations on the economical method of prescribing, the costs and any necessary precautionary measures when prescribing these drugs or active ingredients. If drugs are prescribed in accordance with the therapy instructions, the prescribing doctor is protected against drug recourse. In the event of an abnormality check , these prescriptions must be deducted from the prescription volume. For this, the need for a prescription must be conclusively recognizable from the medical documentation.
These therapy instructions are binding for the contract physicians in the statutory health insurance. Pharmacists do not have to check compliance with the therapeutic instructions when dispensing drugs. As long as the content is correct, the therapy information is permissible according to the case law of the Federal Social Court. This does not violate the rights of pharmaceutical manufacturers to equal access to the statutory health insurance market.
