Pharmaceuticals in general

Additional costs arise for insured persons if the so-called fixed amount is exceeded. This is because the reimbursement of pharmaceuticals is limited to legally defined amounts. These so-called reference prices are maximum amounts for the reimbursement of drug prices.

All health insurance companies therefore do not automatically pay every price, but at most the legally stipulated reference price: these are set for groups of comparable medicines and are redefined at regular intervals, so that their co-payments vary constantly. If a doctor prescribes a drug that exceeds the reference price, the difference is payable as a co-payment in addition to the statutory co-payment.

Pharmaceutical discount agreements with certain pharmaceutical manufacturers offer potential savings for health insurance funds and insured persons. In these contracts, health insurance funds undertake to give priority to purchasing medicines from certain manufacturers for insured persons and receive a discount for doing so. For insured persons, this means that their medicines no longer come from all suppliers on the market, but from certain partner manufacturers. A freely accessible database with non-binding information on all statutory health insurance companies can be found at https://www.arzneikompass.de/.

The BKK W&F exclusively engages reliable and reputable companies for such contracts, which are distinguished by years of experience in the pharmaceutical industry. These medications always contain the same active ingredients as your previous medication and are of the same high quality. Although the color, shape, and packaging may differ, the effectiveness and safety do not.

You generally have to pay for over-the-counter medicines yourself. This includes, for example, medicines for minor illnesses such as colds and flu-like infections or laxatives.

All statutory health insurance funds only cover the costs of medically prescribed, over-the-counter but pharmacy-only medicines,

• if the medicine is intended for children under the age of twelve or is required for adolescents under the age of 18 with developmental disorders;
• if the medication is part of the standard treatment for serious illnesses. In this case, the doctor can also prescribe corresponding medicines for certain indications. The doctor decides on the prescription of these drugs as part of his therapy. Insured persons should therefore always discuss this with the doctor treating them first.