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Kassen do not pay for over-the-counter medications

Kassen do not pay for over-the-counter medications

Patients have to bear the cost of over-the-counter medication themselves

The health insurance does not have to pay for over-the-counter medications. A 74 patient failed in his lawsuit before the Federal Constitutional Court against the refusal to pay his statutory health insurance. Accordingly, although his family doctor had considered further treatment of the plaintiff with the non-prescription drug Gelomyrtol to be sensible and necessary, the health insurance company is not obliged to assume the costs.

The complainant with statutory health insurance has chronic respiratory disease (emphysembronchitis), against which his family doctor has prescribed the use of "Gelomyrtol forte". Since 2004, however, the drug has no longer required a prescription and has therefore been removed from the list of services provided by the statutory health insurance companies. Instead of paying five euros per pack, the plaintiff has since had to pay the full price. As a result, he incurred monthly costs of € 28.80. Chronically ill people are asked to make a special sacrifice and there is inadmissible equal treatment of the acutely ill and chronically ill, the 74-year-old justified his complaint to the Federal Constitutional Court.

No special victim of the chronically ill Since his health insurance company refused to cover the cost of the over-the-counter medication despite the doctor's prescription, the 74-year-old first went before the social court, then before the state social court and finally before the federal social court, which revised the applicant's appeal November 2008 rejected. As the final instance, the Federal Constitutional Court has now decreed that "the constitutional complaint will not be accepted for decision" because it is "partly inadmissible, partly unfounded". The "special sacrifice" made by the plaintiff of the chronically ill in favor of the general public could not be recognized. Especially since the chronically ill spend the cost of non-prescription medication on their own. "But if a person only buys medicines that are useful to him, there is no special sacrifice for the community," said the Federal Constitutional Court.

Health insurance companies do not have to do everything for health According to the Federal Constitutional Court, statutory health insurance companies are "not constitutionally required to provide everything that is available for maintaining or restoring health." According to the court, "reasonable personal contributions can be required. “The fifth social code (SGB V) does not imply an inadmissible disadvantage for the chronically ill. The general principle of equality of Art. 3 Para. 1 is not violated in the Basic Law. The "unequal treatment between prescription and non-prescription medication, which actually results in higher co-payments for the chronically ill, is justified", judged the judges of the Federal Constitutional Court. The regulation on the prescription of medicines in "§ 48 Act on the Traffic of Medicines - Medicinal Products Act (AMG) - in conjunction with § 1 Ordinance on the Prescription of Medicines - Pharmaceutical Prescription Regulation - serves to protect the population", according to the official announcement of the court.

Prescription duty should ensure drug safety The regulation of the prescription duty, according to the Federal Constitutional Court, is intended to ensure that “drugs that involve health risks are only used by those healers who have their effects, side effects and interactions with other agents, contraindications and other dangers know exactly. ”With the prescription requirement, the legislator therefore uses a criterion that“ primarily has the function of guaranteeing drug safety, also with the aim of controlling the financial use of statutory health insurance. ”Here, the differentiation is also proportionate in the narrower sense , because the burden of the additional costs for non-prescription drugs is "in the current case" in a reasonable proportion to the goals pursued by the legislature with this differentiation. "There were no signs of this that the applicant was charged with disproportionate costs. (fp)

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Image: Sara Hegewald / pixelio.de

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