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Higher prices and innovations – More money for medicines and remedies in 2025

October 10, 2024 – The volume of spending on medicines will increase by 5.1 percent nationwide in the coming year. In the medicinal products sector, the KBV and the GKV National Association expect an increase of at least 3.5 percent. This is the result of this year’s negotiations on the framework for 2025.

The increase in spending on medicines can be explained in particular by legislative measures. The fixed amounts for numerous pediatric medicines were lifted on February 1, 2024 in order to improve the supply of children’s medicines. A new base price applies to medicines without a fixed price, which could be increased once by up to 50 percent. In addition, discount agreements for children’s medicines are now prohibited by the Supply Bottleneck Act.

Increase in spending due to new drugs

These requirements, among other things, as well as the inflation compensation for pharmaceutical companies will lead to higher drug prices in 2025 and thus to additional expenditure in statutory health insurance. In addition, the use of innovative drugs is proving to be a cost driver.

“Every year, drugs with new therapeutic approaches come onto the market. If patients can benefit from additional benefits of these medicines, we must take this into account in the expenditure volume,” said KBV board member Dr. Sibylle Steiner from the PraxisNachrichten. “That’s why it was important to us that the health insurance companies provide the necessary funds for this.” Because medically sensible prescriptions should not lead to economic risks for doctors.

Higher drug prices

The expected increase in expenditure on medicinal products is due in particular to additional expenditure on the newly introduced blanket regulation in the areas of physiotherapy and occupational therapy. In addition, additional expenses due to the increase in the price of medicinal products ensure the plus. However, not all price increases for next year have been determined yet, which is why the expenditure volume will probably have to be increased again later.

Further negotiations at the state level

In the framework guidelines, the KBV and the National Association of Statutory Health Insurance Funds evaluate the adjustment factors for the volume of expenditure on medicines and therapeutic products in the following year. Among other things, we look at how prices are likely to develop.

The nationwide framework specifications are the basis for drug and medicinal products agreements that are made regionally by the associations of statutory health insurance physicians and the statutory health insurance companies. In addition to the adjustment factors agreed at the federal level, other factors are taken into account at the state level, for example the number and age structure of the insured.

Medicines: Overview of adjustment factors

The KBV and the National Association of Statutory Health Insurance Funds have agreed on an increase of 5.1 percent for the adjustment factors to be determined nationwide for the volume of drug expenditure in statutory health insurance for 2025. Other factors such as the number and age structure of the insured are negotiated regionally.

Price development +0.7%

Statutory obligation to pay 0%

Guidelines of the Federal Joint Committee 0%

Use of innovative medicines +4.2%

Shift between performance areas +0.2%

Adjustment from 2024 to 2025
+5,1 %

Adjustment factors	Rating for 2025

Remedies: Overview of adjustment factors

An increase of 3.5 percent was agreed for 2025 in the adjustment factors to be determined nationwide for the volume of expenditure on medicinal products. In addition, there may be further price increases due to contracts between health insurance companies and medical treatment providers. As in the pharmaceutical sector, factors such as the number and age structure of insured persons are determined at regional level.

Price development +1.0%

Statutory obligation to pay benefits +2.5%

Guidelines of the Federal Joint Committee

Shift between performance areas

Use of innovative medicines

Adjustment from 2024 to 2025
+3,5 %

Adjustment factors	Rating for 2025

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