The coalition parliamentary groups have once again adjusted DiGA reimbursement. Specifically, an amendment to the draft Emergency Care Reform Act provides for a new reimbursement cut from January 1, 2027. It was passed by the German Bundestag on October 15. Next, it is expected to go to the Bundesrat in November.
According to the amendment, the cut is to correspond to the share of users who stop using a DiGA within the first 28 days. For this purpose, manufacturers are to report the dropout rate to the Federal Institute for Drugs and Medical Devices (BfArM). This is to happen as part of the performance measurement during use. Afterwards, the BfArM is to forward the data to the GKV-Spitzenverband (National Association of Statutory Health Insurance Funds).
Based on this, the GKV-Spitzenverband is to set the cut retroactively for each reporting period and each DiGA. Finally, the health insurance funds are to reclaim the amount from manufacturers. The sponsors of the amendment argued that the cost risk of early dropouts has so far been borne solely by the health insurance funds. As a result, manufacturers would now have an incentive to improve adherence.
However, the SVDGV rejects the reimbursement cut. Even before the decision, it published an open letter and a press release. In them, the association pointed out that volume-based discounts and performance-based reimbursement would not take effect until 2027. Moreover, dropouts are already factored into price negotiations. In the future, they would also be taken into account through performance-based reimbursement.
According to the association, dropouts could also have other causes, for example a treatment goal reached early or a hospital stay. In addition, they would result in additional administrative burden. Therefore, the association is calling for planning certainty and is offering to engage in dialogue.
The Federal Ministry of Health summarizes the decisions of the emergency care reform here: Follow-up regulations to the GKV-BStabG (PDF, German)