The reference price of a medicinal product is the maximum amount, which is reimbursed by the statutory health insurance fund. If the price of a medicinal product is higher than the reference price, the patient generally pays the difference to the reference price or receives a therapeutically comparable medicinal product (without additional contribution).
The current (and prior) lists of reference prices for medicinal products and additional information can be downloaded from the "Downloads" on the German website.
In Germany, there is a two-steps procedure to set the reference prices for medicinal products:
In the first step the Federal Joint Committee (Gemeinsamer Bundesausschuss: G-BA) decides for which medicinal product a reference price can be defined and forms the groups of medicinal products. In these groups medicinal products are combined based on (1) the same active ingredients (2) pharmacologically-therapeutically comparable active ingredients or (3) a therapeutically comparable action.
In the second step the National Association of Statutory Health Insurance Fonds (GKV-Spitzenverband) sets the reference price for the medicinal products. The criteria for the setting of the reference price for a medicinal product are regulated by law. The list of reference prices for medicinal products is updated quarterly and published on the websites of DIMDI.
Please contact the National Association of Statutory Health Insurance Fonds (GKV-Spitzenverband) if you have further questions with regard to contents:
Abteilung Arznei- und Heilmittel
Tel: +49 30 206288-2331