(09/2022) Dr. Bastian Reuter specialist lawyer for medical law, Hackstein Reuter Rechtsanwälte PartG mbB
Of course, the current contribution does not want to compete with the game show of the same name, which ran on RTL from 1989 to the end of 1992. Nevertheless, finding the right price for manufacturers and suppliers in the area of consultation hours is no less exciting - and above all difficult. The complex network of contracts with the Associations of Statutory Health Insurance Physicians with supply contracts based on HAP, AEP and supply contracts without a corresponding reference influences and controls their price policy decisively. The checkout side, in turn, also takes a close look and adapts accordingly in terms of counter-strategy.
Consultation hours are sold in a highly regulated environment. The need for consultation hours includes those products that the registered panel doctor cannot prescribe in the name of the patient, but purchases for all of his statutory insured patients. The need for consultation hours is obtained from contract doctors on the basis of a wide variety of agreements in the individual KV districts from manufacturers, specialist dealers and pharmacies at the expense of the statutory health insurance companies.
The different structure of the contractual agreements in the different KV districts has a direct influence on the requirements for the strategy of manufacturers and suppliers in the area of pricing. The reason: parts of the settlement of consultation hours with the health insurance companies are directly affected by the manufacturer selling price (HAP) or pharmacy selling price (AEP), which must be taken into account accordingly.
In addition, there are differences due to various other billing variants, which should also be taken into account in pricing.
Different requirementsDepending on the KV district, different pricing requirements must be observed. Basically, a distinction must be made between price agreements between health insurance companies and contract doctors based on the HAP and/or the AEP on the one hand and missing price agreements with the result that the health insurance companies are based on the (supposed) actual market price on the other hand.
HAP and AEPPartly take existing Lie
