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The Beneluxa Initiative on Pharmaceutical Policy is a multi-country horizon scanning, HTA and pricing and reimbursement collaboration between Belgium, the Netherlands, Luxembourg, Austria and Ireland.

In conjunction with the published list price, post-launch financial regulation reduces the payer’s net cost and limits overspend when real-world utilisation exceeds the assumptions used at price negotiation.

Retail pharmacy medicines that are reimbursed by statutory health insurance have regulated sales prices that are built up from an approved manufacturer price plus regulated distribution mark up and VAT. Hospital purchasing works differently, with negotiated procurement prices but with specific additional prices payable where national inpatient hospital tariffs cannot cover the drug price.

After a medicine is reimbursed in France, the public payer’s expenditure is shaped by a set of ‘post-reimbursement’ control levers. These act on who can receive treatment, who can prescribe it, what can be dispensed, how quickly lower-cost alternatives are adopted, and how prices evolve as products mature.

Germany has long combined published list prices with confidential net reductions, chiefly through sickness fund rebate agreements and statutory rebates. Since 1 January 2025, confidentiality has become an option for AMNOG reimbursement prices through a legal option to keep the negotiated reimbursement amount off public price and product listings for eligible medicines.

Discount contracts, in the form of sickness fund rebate agreements, are a central mechanism by which individual statutory health insurance funds obtain confidential net price reductions from manufacturers without changing the published list price.

Inpatient add-on payments (Zusatzentgelte, ZE) are a core mechanism used to reimburse defined high-cost items or services in addition to the DRG case payment, within nationally specified rules and an annually updated national catalogue.

Recent reforms under the Medical Research Act (Medizinforschungsgesetz, MFG) are intended to strengthen Germany as a location for clinical research and early launches.

Before the national DRG catalogue of hospital tariffs has been updated to reflect the cost of a new, high-cost medicine , the NUB temporary innovation payment system allows hospital-level, time-limited additional payments to be agreed.

Germany uses reference prices (Festbeträge, FB) to cap statutory health insurance reimbursement for large parts of the outpatient medicines market. The system groups medicines that are considered comparable for reimbursement purposes and assigns a maximum reimbursable amount to each group.

Germany has a legally defined sequence of add-ons for most prescription-only medicines dispensed to outpatients through community pharmacies. The regulated elements are the maximum wholesale add-on and a fixed structure of pharmacy add-ons, with value added tax (VAT) applied on top.

After the Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) has adopted its resolution on additional benefit, the National Association of Statutory Health Insurance Funds (Spitzenverband Bund der Krankenkassen, GKV-SV) negotiates a statutory reimbursement price (Erstattungsbetrag, EB) with the manufacturer.

Germany’s statutory health insurance system applies mandatory manufacturer rebates, a mandatory pharmacy discount, and a price moratorium to reduce net medicines expenditure, while generally leaving published list prices unchanged.

After a medicine is reimbursable in statutory health insurance, Germany uses binding rules and self-governance agreements to influence who receives a medicine, how it is prescribed, and what is dispensed.