The Act on the Reform of the Market for Medicinal Products, which entered into force on the 1st of January 2011, brought about a fundamental change in the balance of power on the pharmaceutical market. This thesis therefore sets out to answer the following question: What impact does the early benefit assessment in the context of the Act on the Reform of the Market for Medicinal Products have on the stakeholders of the healthcare system?
To answer this question, this work first presents the theoretical foundations of the law, of the early benefit assessment and the bodies involved. It then takes stock of the decisions taken to date before describing the impact on the selected stakeholders.
The following findings were reached: As the representative of the statutory health insurance funds, the Central Federal Association of Statutory Health Insurance Funds has gained in power and now decides, as a member of the Federal Joint Committee, on the added benefit of a drug and, depending on this decision, also on the future reimbursement rate. Pharmaceutical companies, however, are losing clout and must comply with the guidelines and assessments of the early benefit assessment. Patients stand to gain and lose out from the early benefit assessment. They are the ones who are ultimately dependent on the medicinal product and its improvement and benefit from a proven benefit. However, they have no say in the early benefit assessment procedure.
Table of Contents
1. Introduction
1.1 Scope
1.2 The central research question
1.3 Methodology
2. The Act on the Reform of the Market for Medicinal Products
2.1 The background of the Act
2.2 The objectives of the Act
2.3 The Federal Joint Committee (G-BA)
2.4 The Institute for Quality and Efficiency in Healthcare
2.5 The manufacturer dossier
2.6 Early benefit assessment
2.7 The special case of orphan drugs
3. Evaluation, findings and experience – Critical analysis
3.1 Evaluation of the added benefit classifications
3.1.1 Methodology
3.1.2 Frequency distribution of the added benefit categories
3.1.3 Comparison of the added benefit classifications
3.2 The impact on the statutory health insurance funds
3.2.1 Overview of the statutory health insurance funds in Germany
3.2.2 Challenges facing the health insurance funds
3.2.3 The Central Federal Association of Statutory Health Insurance Funds
3.2.4 The early benefit assessment from the perspective of the Central Federal Association of Statutory Health Insurance Funds
3.3 The impact on the pharmaceutical industry
3.3.1 The pharmaceutical industry in Germany
3.3.2 A critical assessment from the perspective of the pharmaceutical industry
3.4 The impact on patients
3.4.1 Patient organisation in Germany
3.4.2 A critical analysis from the patient's perspective
3.5 Conclusion
4 Summary and Outlook
Research Objective and Core Topics
This thesis examines the impact of the early benefit assessment introduced by the German Act on the Reform of the Market for Medicinal Products (AMNOG) on the key stakeholders of the healthcare system. The primary research question addresses how this legislative change has altered the power dynamics and economic conditions for insurance funds, pharmaceutical companies, and patients.
- The theoretical and practical foundations of the AMNOG and the early benefit assessment procedure.
- Statistical evaluation of added benefit classifications and decisions made by the Federal Joint Committee (G-BA).
- Economic and strategic challenges faced by statutory health insurance funds in Germany.
- Impact of the "burden of proof" on pharmaceutical companies and the resulting market consequences.
- Patient involvement in healthcare decision-making and the representation of patient interests.
Excerpt from the Book
3.3 The impact on the pharmaceutical industry
The AMNOG heralded a new era for the pharmaceutical industry in Germany: never before was the power of the pharmaceutical companies subject to such restrictions. Until then, they could set the price for their medicinal product as they saw fit - whether appropriate or not. It was then left to the discretion of the health insurance funds or doctors within the framework of treatment freedom whether a possible added benefit could be observed or not. Today, however there is a burden of proof: it is now up to the pharmaceutical companies to demonstrate an added benefit. The SHI thus wants to save millions at the expense of the pharmaceutical industry. "Many pharmaceutical companies fear an abuse of the early benefit assessment" (Dingermann, 2013, p. 770).
Summary of Chapters
1. Introduction: Outlines the scope, central research question, and methodological approach of the study regarding the German healthcare system and the AMNOG.
2. The Act on the Reform of the Market for Medicinal Products: Presents the theoretical background, objectives of the law, and the roles of the Federal Joint Committee and the IQWiG in the assessment process.
3. Evaluation, findings and experience – Critical analysis: Provides a data-driven examination of benefit classifications and discusses the impacts on insurance funds, the pharmaceutical industry, and patients.
4 Summary and Outlook: Synthesizes the results and offers a perspective on future healthcare developments and public health responsibilities.
Keywords
AMNOG, early benefit assessment, pharmaceutical market, G-BA, IQWiG, statutory health insurance, added benefit, comparator therapy, price negotiations, pharmaceutical industry, patient involvement, healthcare economics, medicinal products, cost-containment, orphan drugs.
Frequently Asked Questions
What is the core subject of this thesis?
The thesis investigates the "early benefit assessment" as introduced by the AMNOG legislation in Germany and its effects on healthcare stakeholders.
What are the primary fields of research covered?
The research covers health economics, pharmaceutical law, market access for medicinal products, and the strategic roles of insurance funds and pharma companies.
What is the central research question?
The study asks what impact the early benefit assessment has on the stakeholders of the German healthcare system based on available data.
Which scientific methodology is applied?
The work employs a literature review, an evaluation of official benefit assessment statistics and decisions, and analysis of stakeholder perspectives and workshops.
What topics are discussed in the main part?
The main part analyzes the legal and institutional framework of the AMNOG, the statistical results of benefit assessments, and the critical viewpoints of insurance funds, industry, and patients.
Which keywords define this work?
Core keywords include AMNOG, early benefit assessment, G-BA, statutory health insurance, and pharmaceutical industry.
How does the G-BA influence drug pricing?
The G-BA evaluates the "added benefit" of a new drug compared to a standard therapy, which subsequently serves as the basis for price negotiations between manufacturers and health insurance funds.
Why are pharmaceutical companies considered "losers" of this reform?
The thesis notes that companies have lost significant pricing power, face high compliance costs, and struggle with strict requirements regarding comparator therapies.
What role do patients play in the new assessment procedure?
Although patients are directly impacted, they have no voting rights in the G-BA; however, they are increasingly encouraged to participate as informed experts to advocate for their needs.
What is the "opt-out" solution mentioned in the context of pharma companies?
It refers to the decision by some manufacturers to withdraw or withhold a medicinal product from the German market because the negotiated price following a negative benefit assessment is not financially viable for them.
- Quote paper
- Sara Schlenkrich (Author), 2013, The early benefit assessment in the context of the Act on the Reform of the Market for Medicinal Products (AMNOG), Munich, GRIN Verlag, https://www.grin.com/document/282129
