TABLE OF CONTENTS

4 EXECUTIVE SUMMARY

5 PRICING AND REIMBURSEMENT OVERVIEW
5 Pricing and reimbursement tools
6 Key bodies influencing pricing and reimbursement in Germany
9 Germany has implemented a number of pricing and reimbursement reforms
12 References

13 PRICING ISSUES
13 Reference pricing has long been used as a cost-containment measure in Germany
14 Mandatory rebates are required for patent-protected drugs
15 Rebate level for non-reference priced drugs raised to 16%
16 AMNOG law introduced a number of changes in the German pricing and reimbursement environment
17 Pricing negotiations are based on comparative assessment
25 Efficiency frontier analysis: results in 2012
26 References

30 REIMBURSEMENT ISSUES
30 Negative lists are used in Germany
30 Co-payments as a cost-containment measure
30 Automatic substitution has been in place since 2002
30 Physician prescribing volume targets are used to control pharmaceutical expenditure
31 Prescribing guidelines influence physicians
32 Risk sharing and payer contracting
33 Diagnosis-related group payment scheme used for reimbursement of inpatient treatment
34 References

LIST OF FIGURES
7 Figure 1: Germany – key bodies influencing pricing and reimbursement
19 Figure 2: Germany – price negotiation procedure according to new rules
26 Figure 3: Germany – efficiency frontier analysis in its cost-effectiveness evaluation

LIST OF TABLES

5 Table 1: Germany – a range of pricing and reimbursement tools are used
9 Table 2: Germany – key healthcare reforms, 2002–10
14 Table 3: Germany – rebates on non-referenced priced drugs and prescription drug price
freezes, 1993–2010
32 Table 4: Germany – pharma-payer contracts for patented products, 2009