Ärzteblatt reports on a decision by the Regional Social Court of Berlin-Brandenburg (case no. L 4 KR 196/23 KL). It confirms the authority of the arbitration board in deciding DiGA prices.
DiGA manufacturers negotiate the permanently reimbursed price with the National Association of Statutory Health Insurance Funds. If no agreement is reached in these negotiations, an arbitration board decides. The manufacturer of an obesity app had now brought an action against the arbitration board’s decision. The claimant argued that at the price set by the arbitration board, the app could not be offered economically.
The court did not accept this reasoning and dismissed the action almost entirely. The arbitration board is permitted to make its own calculations to determine the price. Where these are communicated voluntarily by the arbitration board, as happened in this case, that does not make the decision open to challenge. This is also true where the manufacturer describes the assumptions as inaccurate.
Read more in the Ärzteblatt article:
DiGA: Schiedsstelle hat Spielraum bei Entscheidungen – News – Deutsches Ärzteblatt