"Aut idem" is Latin and means "or the same thing". This refers to the replacement of one drug with another drug of the same medicinal product. This exchange process is also called substitution. The new legislation (AABG) uses "aut-idem" to mean the replacement of an expensive drug with a lower-priced, drug-like preparation from the lower price range.
The AABG came into force after its publication in the Federal Gazette on 23 February 2002. Since no price-third-party limits can be set before the establishment of therapeutically comparable forms of administration of the individual active substances (proposals made by the Federal Committee of Physicians and Health Insurance Funds) (calculation by the Federal Association of Health Insurance Funds), the AABG can only gradually be implemented. Since 1 July 2002 the AABG is to be used for 170 aut idem groups.
When does auto-idem substitution occur and when not?
The substitution is provided:
- in drug regulation. The pharmacy must select in these cases a product from the lower third of the price for delivery (= cheap by law).
- when prescribing a preparation that is not in the lower third of the price (unless the doctor has ruled out the substitution on the recipe sheet).
If no price-thirds were set for an aut-idem group under the AABG, as fewer than five drugs were offered in the calculated lower third of the price at the time of calculation, one of the five cheapest products can generally be sold.
No substitution is provided:
- if the doctor has already prescribed cheap.
- if the doctor forbids this by ticking on the prescription (or a note) - no matter how expensive the prescription is.
What does "aut idem" mean for the patients?
The order is still made by the doctor. The pharmacist must deliver a low-priced drug. Unless the doctor forbids the pharmacist on the recipe sheet by a cross in the aut-idem box, the substitution.