Probing a new Grand Coalition between CDU/CSU and SPD – Quo vadis Rx-mail-order-ban?
About the author
Prof. Matthias P. Schönermark, M.D., Ph.D.
Founder and Managing Director
Founder and Managing Director
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Fax: +49 511 64 68 14 18
The initial attempt of a ban failed in March this year due to a veto of the SPD-led ministries of economics and justice. The ban was intended to prevent the increased practice of European mail-order pharmacies circumventing existing price fixing regulations in Germany by referring to European law and thereby gaining a competitive advantage through discounts. The legislative initiative of Federal Health Minister Hermann Gröhe was a response to a ruling by the European Court of Justice (ECJ) in October 2016, in which the EU's supreme judicial body assessed the German price fixing regulation for prescription medicines as a violation of EU law.
While CDU/CSU continues to support the present draft for a complete ban on the mail-orders of prescription drugs, the Social Democrats continue to position themselves in opposition to a generalized ban in their general election campaign. However, as early as January 2017 – and thus even before the first legislative attempt failed – SPD health expert Prof. Dr. med. Karl Lauterbach moved forward with an attempt to compromise, suggesting that a ban may be discussable if in return chronically ill patients become exempt from any additional payment and thereby sparking discussions within his own party. A different solution from the ranks of the Social Democrats was recently proposed by the Bavarian Association of Social Democrats in Health Care (ASG), calling in a resolution to prohibit Statutory Health Insurances from reimbursing prescriptions from (international) pharmacies who do not fully align with existing German regulations and therefore do not comply with the price fixing regulation.
However, a completely new situation may arise if the negotiations between the Social Democrats and the Christian Democrats fail, leading to a potential minority government by CDU/CSU. While both Greens and Liberal Democrats are campaigning for a liberalization of drug sales and thereby arguing against a ban on the mail-order of prescription drugs, left-wing Democratic Socialists (Die Linke) are supporting a total ban of Rx mail-orders. Since neither the party program nor the election campaign of the new right-wing party Alternative für Deutschland (AfD) comprise a position on this issue, at least the theoretical option of a very unorthodox majority between conservatives and the most extreme left- and the right-wing parties represented in the Bundestag may arise.
Prominent support for a revision of the current set of rules and in favor of a Rx-mail-order-ban comes from Prof. Josef Hecken, impartial chairman of the Joint Federal Government (G-BA). In a recent interview with the Pharmazeutische Zeitung (48/2017), he describes the current legislative situation as "fatal" and comments that he sees "no alternative to the approach" other than the one of the outgoing Federal Minister of Health. Regardless of possible majorities, however, it will still be necessary to clarify in principle how a ban in any form may be defined which can withstand a possible new assessment of the ECJ.
BY Prof. Matthias P. Schönermark, M.D., Ph.D., Founder and Managing Director, SKC Beratungsgesellschaft mbH
The complete interview from "Pharmazeutische Zeitung" with Prof. Josef Hecken can be found here.