gms | German Medical Science

14. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

15.11. - 16.11.2007, Frankfurt am Main

The effect of recent legislatory changes on prescribing patterns in Germany

Meeting Abstract

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  • corresponding author S. Gutschmidt - Wissenschaftliches Institut der AOK (WIdO), Bonn
  • G. W. Selke - Wissenschaftliches Institut der AOK (WIdO), Bonn

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 14. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. Frankfurt am Main, 15.-16.11.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. Doc07gaa09

The electronic version of this article is the complete one and can be found online at:

Published: November 12, 2007

© 2007 Gutschmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Context: Time and again new legislatory measures have been introduced to curb the increase of drug expenditure in the statutory health insurance sector (GKV). 2006 changes have specifically addressed physicians through setting global targets based on a benchmarking approach, and patients in order to increase cost-awareness.

Aim of the study: To analyse the effectiveness of the measures and to identify the mechanisms through which the targets are achieved (if at all).

Material and method: Complete prescription data in the GKV sector for the period from January 2006 (pre-legislation) to June 2007 were analysed retrospectively with respect to prescribing volume, expenditure and cost per DDD for the substances affected by the changes. Regional differences and changes over time are described. By choosing appropriate time intervals for comparisons, the effects of each individual of the new measures, which took effect at slightly different times, are quantified separately.

Results: Measures aimed at physicians show a marked effect nationwide: usage of analogue substances has declined substantially, to the benefit of well-established primary substances, and cost per DDD was reduced both through switches to lower-cost substances and through generic substitution. Regional variations were compressed. Measures ostensibly aimed at patients, viz., co-payment waivers for low-price generics, also show a marked effect; however, not through changes in prescribing patterns but through price decreases as a consequence of increased pressure anticipated by manufacturers.

Conclusion: Physicians are deciders not only with respect to choice of therapy under consideration of efficacy but also with respect to choice of cost-effective treatment. Targeting specific fields of therapy for increased cost-effectiveness and defining comprehensible incentives for meeting targets can induce changes of prescribing patterns in the direction desired. Incentives for patients, however, do not result in changed demand patterns. Instead, they exert indirect pressure on the pricing habits of manufacturers.