/dpa
Berlin – All hospitals nationwide will in future be able to administer the monoclonal antibody Nirsevimab (Beyfortus), which has recently been recommended to infants by the Standing Vaccination Commission (STIKO) to prevent serious infections caused by respiratory syncytial viruses (RSV).
There is no need to submit applications to provide the service nor to negotiate remuneration. They have now agreed on this National Association of Statutory Health Insurance Fundsthe Association of Private Health Insurance (PKV Association) and the German Hospital Association (DKG).
Remuneration in hospitals is usually based on flat-rate fees. For new examination and treatment methods (NUB) that cannot yet be adequately reimbursed with the flat-rate fees, hospitals have the option of agreeing on separate fees, so-called NUB fees.
A prerequisite for this is that hospitals obtain information from the Institute for the Hospital Remuneration System (InEK) as to whether the new method can be properly billed with the existing flat-rate fees. The InEK has confirmed that the criteria for agreeing a NUB fee are met for nirsevimab.
As the Federal Ministry of Health had already emphasized in July, 430 clinics nationwide had submitted a corresponding application. That would have meant that only a small number of houses would have been allowed to bill for the service.
The PKV Association, the National Association of Statutory Health Insurance Funds and the DKG have now solved this problem together. Such a query and application is no longer required. The houses also no longer have to individually negotiate a reimbursement amount for this service. A reimbursement price – a fixed price, so to speak – is now planned for this service for all hospitals.
How high this will be is currently still open. The current price in the Lauertaxe for Beyfortus is 416.50 euros including VAT. According to information from German medical journal The National Association of Statutory Health Insurance Funds and the manufacturer Sanofi are now negotiating a reimbursement price for Beyfortus, which in turn should then be the reimbursement price for all hospitals.
Until the reimbursement amount is agreed between the National Association of Statutory Health Insurance Funds and the pharmaceutical company, which is expected for spring 2025, the waiting tax is considered the reimbursement amount.
The costs for advice and administration should be reimbursed via the flat rate per case for the newborn. According to reports, six million euros will be made available for this purpose, which the InEK will add to the entire system, as it was said. How many doses will ultimately be needed remains to be seen. The total sums that are being negotiated also apply.
Just over two weeks ago, the Federal Ministry of Health regulated for the first time the right of insured persons who have not yet reached their first year of life to the prophylactic administration of a monoclonal antibody with an ordinance on the right to specific prophylactic measures against the RS virus.
The ministry’s regulation and the STIKO recommendation stipulate that children born between October and March can, if possible, receive the monoclonal antibody before they are discharged from the hospital.
The aim of the regulation is to reduce the frequency of severe RSV diseases in newborns and infants and to prevent RSV-related hospitalizations, intensive care treatments and RSV-related deaths as well as inpatient and outpatient care shortages. © may/aerzteblatt.de
