(03/2022) Dr. Bastian Reuter, specialist lawyer for medical law, Hackstein Reuter Rechtsanwälte
No exclusion of SSB suppliers through discount agreements according to § 130a Para. 8 SGB V - Consultation hours requirement regulation as a guarantee commitment in favor of the supplier - Obligation to observe the cost-effectiveness requirement (consultation hours requirement agreement) applies solely to the contract doctor as prescriber.
The State Social Court (LSG) of Baden-Württemberg has clarified that discount agreements between the health insurance funds according to § 130a Paragraph 8 SGB V with individual consultation hour suppliers, possibly after a tendering process, do not exclude other suppliers from the consultation hour supply. Rather, the health insurance companies can only make specifications for compliance with the cost-effectiveness requirement in this way. The basis of the decision was the consultation hours agreement for the Rhineland-Palatinate area, which provides for a doctor's prescription of the consultation hours and requires direct purchase from the manufacturer or wholesaler if this direct purchase is more economical. Billing takes place either by paying the invoice to the supplier or by reimbursement of the invoice amount to the contract doctor.
No exclusion of suppliers through discount agreements
According to the court, health insurance companies cannot exclude other suppliers by concluding discount agreements. The health insurance company that was the defendant in the proceedings had initially concluded exclusive framework agreements “for the supply […] with contrast media” with various pharmaceutical companies for individual contrast media for the Rhineland-Palatinate district together with other health insurance companies in 2020 with the help of an EU-wide tender. Accordingly, she now took the legal view that the conclusion of the framework agreements excludes all other suppliers from supplying contract doctors.
The LSG Baden-Württemberg has now countered this view with clear words with a view to the area of need for consultation hours. It correctly points out that the relevant agreement on the need for consultation hours alone does not justify such an exclusive assignment of the delivery correction. The relevant agreement on the need for consultation hours only contains a general obligation to comply with the principle of cost-effectiveness and a request to the doctor to choose a favorable procurement method for the prescription and -
