Medication | Cash registers in the cost trap

A thickened cardiac septum like the one in this photo can be an intermediate stage of heart failure. Photo: IMAGO/BSIP The statutory health insurance companies' pharmaceutical expenditure is rising faster than their income. That much has been clear for a long time. To date, the greatest increases in drug costs have been attributed primarily to those preparations that are both innovative and still protected by patents. And they are most often used for cancer. The new drug report from the Barmer health insurance company now focuses on another aspect, namely the treatment costs of so-called common diseases. The study was presented on Wednesday in Berlin.

Now the crux of common diseases is that there is no definition for them. The consensus is that these diseases are very widespread in the population - and also have major health and economic impacts. These include cardiovascular diseases, cancer, diabetes mellitus, mental illnesses and those of the musculoskeletal system. Barmer has now examined heart failure and bronchial asthma for her examination.

“The health insurance companies want advanced therapies.”

An average of 130,000 new cases of heart failure (or insufficiency) are diagnosed in Germany every year. Around four million people in total live with such a diagnosis. The risk increases sharply with age, so from a purely demographic perspective, it is to be expected that cases will continue to increase for some time. The most common causes include high blood pressure, coronary heart disease, including heart attack, as well as heart valve defects and myocarditis.

Barmer now points out that the health insurance fund's total expenditure on drug therapy for heart failure increased by 121 percent between 2014 and 2024 - to 441 million euros. There has been a disproportionate increase in spending on patent-protected medicines - namely by 183 percent. However, Barmer board member Christoph Straub admits that these new, expensive medicines also have something for patients. The SGLT2 inhibitors, for example, relieve the strain on the heart via the kidneys. Its approval was expanded in 2020 for chronic heart failure. The pharmacy prices here are 2.36 to 2.42 euros per tablet. However, the therapy usually consists of three other active ingredients.

What is probably also worrying Barmer is the prospect that the so-called weight loss injections or their active ingredients (which will probably also be available as tablets) will also show their positive effects on certain heart failure in combination with obesity. Further price wars can be expected here. In any case, expenses could increase significantly again at this point.

However, as with other diseases, the medications used to treat heart failure should benefit all patients based on the current state of scientific knowledge. Straub attaches great importance to this: “The health insurance companies want advanced therapies.” However, the question is how the contradiction between faster growing therapy costs and slower revenue growth can be resolved.

The Barmer board sees a need for political action here: Among other things, the additional benefit that patients have with a new preparation compared to older (usually off-patent) products would have to play a significantly larger role in determining prices. It is also important to consider the extent to which a medication is used. »If the fixed costs are covered, the price cannot continue to grow. This applies in many areas, including health care,” Straub points out. “Why not with the medication too?”

Report author Daniel Grandt also repeats the general demand of the statutory health insurance funds that economic development for pharmaceutical manufacturers should not be carried out through excessive reimbursement prices on health insurance costs. Barmer representatives see further leverage in possible renegotiations on drug prices if the situation on the market changes or if the actual benefit is proven. In addition, the very expensive preparations should only be used by really qualified institutions and doctors.

Last but not least, prevention should play a much greater role: only half of the decline in mortality from cardiovascular diseases is due to innovative drugs. Reducing risk factors is responsible for the other half. Barmer has developed the “More Healthy Years” strategy on this topic. One step forward from the insurance company's perspective is that health insurance companies can now also inform those insured specifically about prevention options and make suggestions to them. But the issue cannot be shouldered by the health insurance companies alone, emphasizes Straub: “Unemployment is also a major health risk.” And calls for appropriate economic policy in this context.

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