Since February 2002, the exception is the rule: The pharmacist should now select a low-priced drug under the same preparations. Thus, the pharmaceutical expertise of pharmacists can help to save even more effectively with medicines. But as simple as it sounds, the practice of the Expense Reduction Act (AABG), unfortunately, not designed. Many insured are insecure: Do I still really get what helps me best?
"Aut idem" - or the same
Even so far it was already possible that the doctor allows the pharmacist to deliver an active substance-like preparation instead of the prescribed one. In particular, in emergency service or if the therapy should start immediately, the doctor could tick the box "aut idem" on the recipe. This enabled the pharmacist to immediately provide the patient with an effective remedy, even if he did not have the prescriptive remedy of a specific company in stock.
A prerequisite for "aut idem", ie the delivery of the same drug: The replaced drug must contain the identical drug in the same amount and the same dosage form, ie either suppositories, juice, drops or tablets. With the new law now the exception becomes the rule.
Save with medicines
With the new law, Health Minister Schmidt hopes to save € 250 million. The quality of the therapy with medicines should not suffer, because still every physician is obliged to prescribe the necessary medicines to the patient. As studies have shown, effective and affordable drug therapy can effectively limit drug costs. So it should not be saved on medicines, but with medicines.
Thinking economically is not new
How much the health insurance companies had to spend so far for drugs, was so far mainly in the hands of doctors. They determined with their selection what the pharmacist was allowed to give to the patient. In the past, there was a demand that he should prescribe "economically" by selecting a low-cost supplier for preparations manufactured by many companies. This has only become possible after patent protection for many remedies has expired.
Only when a manufacturer "just" has to replicate a drug and thus save the expensive research costs, can he lower prices compared to the original manufacturer. With these so-called generic drugs, which must be bioequivalent to the original preparations, that is just as effective, the doctor was also able to prescribe his patients inexpensive medicines. Despite all the efforts of the doctors, health insurance expenditures also increased contributions to the statutory health insurance funds.
Pharmacists help cut costs
Even with the current regulation of the "aut idem" the doctor is still responsible for the drug therapy of his patients. He can now take care of his patients more intensively, because the pharmacist should now ensure that a low-priced drug is delivered. In terms of the law, all drugs that are in the lower third of the price of a list of active-ingredient equivalents are cheap. Since 1 July 2002, lists have been drawn up for 112 active substances.
"Aut idem" in practice
In order to achieve the government's savings goal, there are various possibilities for "aut idem" in practice:
- The doctor prescribes a medicine that is not cheap and he does not check the "aut idem" box on the prescription. The pharmacist must then make a cheaper drug from the lower third of the price of all available drug-equivalent funds. It is also not allowed that the patient receives the expensive original preparation by paying the price difference to a calculated on the recipe low-priced funds.
- If the doctor tickes the box "aut-idem" on the prescription form, then the pharmacist must deliver exactly this remedy and no other, no matter how expensive the drug is.
- If the doctor already prescribes an inexpensive remedy, then the pharmacist may not replace it with another remedy. He is then bound to the regulation as in the second case.
- If the recipe is next to the strength and the quantity only the name of the active ingredient, without which a specific company is called, then again the "aut-idem" rule applies, according to which a low-priced agent must be delivered.
Choice not at any price
When choosing the "aut-idem" rule, it's all about saving money. However, this is not at any price, because the active ingredient, potency and size of the pack are not the only criteria that the pharmacist must pay attention to. For example, even though it belongs to the lower third of a product, it can not replace the prescribed one if it is not authorized for the same indications (indications).
Also in the dosage form, ie how the drug is packaged, it depends on the expertise of the pharmacist. For example, if a metered dose inhaler is prescribed to an asthmatic instead of a carhaler, the pharmacist should explain to the patient how to use it to achieve the same therapeutic effect. Although the active ingredients are the same, the excipients may differ from preparation to preparation. Also in this case the pharmacist helps if a patient is allergic to a certain excipient, for example corn starch in tablets, or can not tolerate a preservative for eye drops. He then chooses an alternative means that gets the patient well.
Ask the doctor and pharmacist
In particular, if the patient gets a drug for the first time, or he desperately needs the medicine in an emergency, "aut-idem" helps. So that the customer gets his preparation as quickly as possible, it is ideal if the doctor prescribes only the active ingredient in these cases. The close cooperation of doctors and pharmacists guarantees a low-cost drug therapy, which ensures that the contributions to the statutory health insurance remain stable. Above all, the pharmacists contribute by their expertise and their expertise to the fact that the patient tolerates his medication well.