Increasing numbers of statutory health-insurance funds in Germany are opting to call tenders for exclusive discount contracts for the supply of cytostatic preparations for cancer patients from pharmacies.
Implications | The contracts are controversial, considering that they limit patients' choice, and their logistical complexity raises concerns over potential issues regarding safety and timeliness of delivery. |
Outlook | Statutory funds are seeking to expand the scope of discount contracts to new areas, but it remains questionable whether it will be possible for the funds to secure sufficient savings from these contracts to justify their complexity and challenges. |
DAK Gesundheit, Germany's third-largest statutory health-insurance (SHI) fund, and GWQ ServicePlus, a logistics service provider, have called tenders for exclusive discount contracts for the supply of cytostatic preparations in oncology, as reports Deutsche Apotheker Zeitung. These are the first nationwide contracts of their type, the source reports; GWQ ServicePlus is operating on behalf of more than 50 smaller SHI funds in the tender. According to the source, about 15 million individuals are insured by DAK Gesundheit and the funds being represented by GWQ ServicePlus in the tenders, and the annual value of the exclusive contracts for cytostatic preparations – which are prepared by pharmacists, who will be the participants in the tenders – is EUR427 million (USD471 million).
The source reports that the responsibility of supplying the oncological preparations for the funds concerned will be split into 322 exclusive contracts, with contracts due to be awarded in September, and to commence from the beginning of November (with an initial duration of one year); the purpose of the long interval is to allow pharmacies sufficient time to prepare, the source states.
The awarding of exclusive contracts for the supply of cytostatic preparations is highly controversial, owing to the complexity involved with the drugs' supply – mainly because of a limited shelf-life, with some having to be used within 24 hours of preparation. As Deutsche Apotheke Zeitung reports, the exclusive contracts raise questions over whether the safety and timeliness of the supply of these drugs can be guaranteed.
The source reports that an increasing number of SHI funds are becoming involved in exclusive contracts for these drugs, after a decision by Germany's Federal Social Court in November 2015 involving a pharmacist who continued to supply cytostatic preparations to patients, in spite of lacking an exclusive contract to do so with a particular SHI fund. Initially, the Social Court in Darmstadt had ruled in favour of the pharmacist, ordering the fund in question to pay the pharmacist for the preparations supplied; however, the Federal Social Court decided that patients' right to choose the pharmacy could not outweigh the "efficiency principle" unless there were "compelling medical reasons".
Other SHI funds that have launched tenders (with some contracts already having been awarded) for the supply of cytostatic preparations include AOK Hessen (which was the fund involved in the legal procedure), AOK Nordost, AOK Rheinland Hamburg (these three funds called a joint tender for contracts due to begin on 1 August), and Knappschaft-Bahn-See. As Deutsche Apotheker Zeitung reports, the main criterion in each case is price. The source reports that in the case of the Knappschaft-Bahn-See tender – called in May, with contracts to begin in September – the stipulated conditions include that the pharmacy deliver to the prescriber within two hours, with a EUR60 fine for each hour of delay, and higher fines for failure to deliver.
Outlook and implications
The question of discount contracts for cytostatic preparations prepared in pharmacies has already been raised in Germany's federal parliament, with a spokesperson for the coalition government answering an April enquiry with assurances that there were no reasons to expect that the pharmaceutical care of cancer patients would be put under threat. However, with larger SHI funds set to begin implementation of these exclusive contracts, the implications of any problems associated with the contracts become far more serious and concerning.
SHI funds are moving forward with use of the discount contract model in additional contexts, including an increasing number of innovative medicines. The model is one of the funds' most assured guarantees of securing substantial savings, their pursuit of additional discount contracts in different areas is therefore natural. However, since most of the medicines that fall under the contracts for cytostatic preparations are originators – many of which are still patent-protected – the level of any discount that it will be possible to obtain remains questionable.