Expenditure on pharmaceuticals rises to record level

Around 70,000 women in Germany are diagnosed with breast cancer every year. For many of them, the last hope is Keytruda. The drug inhibits the growth of cancer cells and is also prescribed for other types of cancer.

The statutory health insurance funds spent more than 1.3 billion euros on this one drug alone last year. An increase of 16 per cent. This makes Keytruda the best-selling drug of the year, followed by Eliquis and Xarelto, both used for cardiovascular diseases. All three drugs are under patent protection. „Patent medicines are price drivers“, says Marius Milde, Managing Director of AOK Plus. „Although doctors are not prescribing more of them, they are becoming increasingly expensive.“

This is also confirmed by an analysis by the Scientific Institute of the AOK (WIdO), which was presented on Tuesday. According to the analysis, the statutory health insurance funds spent a total of 52.9 billion euros on medicines alone last year - a new record. The study analysed the prescriptions filled in public and hospital pharmacies for around 70 million patients with statutory health insurance. Compared to 2013, the net costs have increased by 88 per cent. The number of prescriptions has only increased by 12.6 per cent in this period.

Pharmaceutical companies determine sales price

The scientists see the causes of the higher costs primarily in the annually increasing pack prices. According to the analysis, prescription-only finished medicinal products cost an average of 1,763.32 euros in December 2022. An increase of almost 40 per cent compared to the same month last year. The average price per pack of patent-protected medicines, known as originator medicines, rose by 44.4 per cent to 20,631.41 euros in the same period. This means that more than every second euro was spent on patent-protected medicines.

„The long-standing trend of patented medicines costing more and more, but at the same time contributing less and less to healthcare, continued last year,

explains Helmut Schräder, Managing Director of the WIdO. Original preparations accounted for only 6.8 per cent of prescribed daily doses last year. In 2013, the figure was still 12.2 per cent.

Saxony's largest health insurance provider, AOK Plus, also has to spend more and more money on medicines - last year more than 692 euros per insured person, an increase of 4.5 per cent on the previous year. „We need new pricing mechanisms. Otherwise the solvency of the statutory health insurance funds could be jeopardised," says Marius Milde. This is because pharmaceutical companies are initially free to set their own sales price for a drug. Only later can health insurance companies negotiate discounts or price reductions with manufacturers and pass the savings on to their policyholders.

According to the WIdO analysis, relatively high costs are incurred by new drugs that do not offer any additional benefits compared to existing drugs. In 2021 alone, the statutory health insurance funds would have spent 3.8 billion euros on this. The statutory regulations on early benefit assessment and downstream price negotiations introduced in 2011 clearly only have a limited influence on the pricing of patented medicines," says Schröder. A large number of these new drugs obviously do not improve the quality of care.

House doctors prescribe the most medicines

According to the WIdO analysis, around 15.2 per cent of all drug costs are attributable to patent-protected cancer therapies, which, however, account for just 0.4 per cent of all prescriptions. In total, the statutory health insurance funds spent around 8.1 billion euros on original drugs for cancer diseases - around 2,500 euros per prescription. Off-patent drugs, so-called generics, cost just under a fifth of the price of patent-protected drugs at 450 euros per prescription. After patent expiry, prices usually fall sharply due to competition from generics providers.

The analysis also shows that most medicines - measured in daily doses - were prescribed by GPs last year, followed by GPs working in internal medicine. The highest average costs were incurred by specialists in haämatology/oncology. In terms of patients, 80 to 84-year-olds received the most medication. Around 15 per cent more drugs were prescribed for women than for men.

AOK Plus boss Marius Milde is calling for more transparent pricing in the face of further increases in pharmaceutical expenditure. It should be made clear what proportion is attributable to research and development, sales, personnel and profit. Milde: „Currently, what society is prepared to pay is what is called for.“

The pricing of single-use drugs such as Zolgensma for muscle atrophy is also problematic. After some time, it often turns out that the single dose is not enough or that the effect wears off and the patient has to switch to another medication. The prices are made for an effectiveness of around 30 years, but have only been proven for three years.

Article in the "Sächsische SZ" from 7 November 2023