Prescription drugs, pharmacies, and insurance

72 posts in this topic

Posted

My doc has prescribed some pain killers for my back, but I find myself in a rather confusing state. I don't know how much these things will cost me and what do I have to do when I go to the pharmacy.

So as far as I see it (I'm a public insurance peon), I have to pay €10 for the doc per quarter and then I have to pay a percentage of the prescription value ? My doc said it would cost about €60 for these pills ? But I am wondering do I pay 50% or what ? Do I have to submit the receipt or do they just take my insurance card when I collect the drugs ?

I know I could find this out by going to the pharmacy myself, and then asking, but I want to know how much money I should bring and what should I bring. And then I need to lookup the vocab on LEO to make sure I don't get screwed by these people.

Also next week I am in Austria and Italy, would it be cheaper to buy the drugs there?

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Posted

On public health insurance you pay 10% of the cost of the prescription per item.

But there is a minimum of €5 and a maximum of €10.

So if the retail price of the tablets is € 60 youwill pay € 6.

Note: If you are a regular taker of a certain medicine always ask the doctor for the largest size, called N3.

You can get it significantly cheaper as say the retail price might be 20, 30 or 50 Euros for the three sizes, all carrying for you a € 5 fee.

Prescriptions are only redeemable in Germany except the postal pharmacies operating out of Holland.

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Posted

Thanks for the tips. Now to spend the afternoon munching pills !

I only have one course of drugs availble on my prescription AFAIK :(

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Posted

My doc has prescribed some pain killers for my back (...) it would cost about €60 for these pills (...)

Also next week I am in Austria and Italy, would it be cheaper to buy the drugs there ?

I only have one course of drugs availble on my prescription AFAIK

That sounds like a lot of money for painkillers - are you sure they're not anti-inflammatories? Either way, if you think you might need more than one course of drugs, after getting the prescription filled you can take the packaging and the info leaflet with you to Austria & Italy, the same pills or their generic equivalent might be available over the counter there, you never know.

Good luck, hope you feel better soon! :)

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Posted

If at all possible, German doctors already prescribe generics and/or re-imports to get costs down.

A retail price of €60 does seem high, I pay mostly the €5 minimum on prescriptions that have a full retail price of way under € 50

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Posted

Hi, does anyone know how it works with private insurance? I have a private insurance and the prescription for my allergy itself came up to €50, not to mention the €300 charge for the allergy test! As I have the option to claim back half of my paid premium if I make no claims throughout the year, I'm just accumulating the charges but it would be good to know if I can claim back prescription from the insurer.

And can I ask my doctor in Germany for a prescription and with the prescription get the drugs elsewhere? Because it costs so much here! (And unfortunately the drug I have to take is prescription only, even in the USA)

AND I had a custom-made insole. Can that be claimed too?

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Posted

ZImmer: there is no conrete reply anyone can give you because the coverage of private insurances does so widely differ. With some insurances the cases you mentioned would be covered, with others only partially and others not at all. This will depend on your concrete contract and you will need to show someone the contract who can answer your questions based on the small-print. Good luck!

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Posted

And can I ask my doctor in Germany for a prescription and with the prescription get the drugs elsewhere?

Prescription drugs are generally over priced in Germany as there is little incentive or method to get the costs down.

Doctors can and will prescribe generics where available and/or re-imports so you should ask for that.

Getting a German issued prescription redeemed by a pharmaicst outside of Germany is probably very difficult though have a look at the online phamracies in Holland. DocMorris ???

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Posted

On public health insurance you pay 10% of the cost of the prescription per item.

But there is a minimum of €5 and a maximum of €10.

So if the retail price of the tablets is € 60 youwill pay € 6.

I've been paying more than €10 each time! Is something wrong? I am right now looking at the pharmacy receipt from the previous illness, it says €15,40.

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Posted

Then you must be a private kasse patient.

I just checked the federal health ministry site for public patient rules and it says:

Grundsätzlich wird bei allen Leistungen eine Zuzahlung von 10 Prozent der Kosten erhoben.

Höchstens allerdings 10 Euro, mindestens 5 Euro. Wenn die Kosten unter 5 Euro liegen, wird der tatsächliche Preis gezahlt.

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Posted

No, Techniker Krankenkasse.

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Posted

Right, thought that answer might be coming. :)

What I SUSPECT has happened is that your deoctor has prescribed You a medicine that is NOT covered by the public health system.

This is generally either "prescribed" on a (blue I think) prescription a medicine that is also available as an OTC.

ie it's more of a reccomendation. Some of these products were previously available as prescriptions but no longer.

Top of my head, anti-histemines, cures for common cold, cough syrus etc.

Or it's a medecine for which you legally need a prescription but is NOT covered by the public health system.

these are prescribed on green (I think) slips but I can't think of a type of medicine that falls in this category off hand and I myself have manbe experienced this once.

So if you got a prescription charge at the Apotheke for a single item of EUR 15,35 then it must have been in one of those categories.

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Posted

Ah thank you.

2 items, on a green slip. For sore throat. So which is the colour that I should not be paying more than 10 euros for? Good to know so I can keep a look out for it. Fact is that I am always ill.

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Posted

Prescriptions for which the "10%, minimum €5, maximum € 10" rule apply are all pink.

ie, they MUST be prescribed by a doctor and they are covered by the public health system.

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Posted

Thanks.

The green one came from a doctor too...at least I thought so :o I may be off to see him again today, another sore throat coming.

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Posted

Sing, I'm not having a go at you, I'm a nice guy really. :)

If you are often going to the doctor and getting these prescriptions then something is wrong.

Either you are always running to the doctor a bit too often and costing the system money and resources when you could just swing by the pharmacy yourself.

Or you have a deeper in the HNO, sorry ENT area that needs a better look at.

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Posted

:) No offence taken.

It's a recurring illness that at one time I even thought it could be cancerous. But ENT / HNO specialists here and at home, tell me it's just due to stress. I see the same doctor, as in I do not jump around, so the doctor should know how often it comes back.

But I don't quite understand the part about costing the system money. I think I pay quite a bit of money for the premiums, something close to 300 eur (my share) so I try to see the doctor as often as I can :)

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Posted

alot of cold meds are not covered by Kasse, just as nosedrops or cough syrup. So, you may get a prescription but the Kasse doesn't cover it like MT said.

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Posted

But I don't quite understand the part about costing the system money. I think I pay quite a bit of money for the premiums,

something close to 300 eur (my share) so I try to see the doctor as often as I can

For every visit you make to the doctor, the kasse pays the doctor X Euros.

Yes, you are "getting your money's worth", but that visit to the doctor "isn't necessary" and that X Euros x each visit is removed from the system

and worsens the already shaky finances of the public health system.

Like I said, not a personal go at you. :)

If it is a previous, serious condition, maybe it makes sense to go to the doctor but the medication is not covered by the public scheme.

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Posted

Ok, thank you :)

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Posted

I didn't realise that anything which you could buy over the counter would not be covered at all by the Public health insurance. If you need to take anything which is available without prescription, and you don't need to get your hands on it immediately, it's worth checking out the online chemists, as they are often significantly cheaper. For example, the anti-histamines I take for hayfever are nearly 50% cheaper online than the RRP I'd pay in the chemists.

On public health insurance you pay 10% of the cost of the prescription per item.

But there is a minimum of €5 and a maximum of €10.

Does anyone know, is the max '€10 per item' really per item on the prescrition regardless of the quantity (as in the UK), or is it really €10 per unit? I also take a nasal spray for the hayfever which is 'rezeptpflichtig', and looking at the online chemists, the largest i can find is 140 doses, which will last just over a month. If I get the doc to give me a prescrition for 5 of these (my hayfever usually lasts right through till September, and reagrdless of the cost I don't want to have to go back to the doc every month just to get another prescription), will all 5 be classed as 1 item (costing me €10) or will each one be counted as a separate item?

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Posted

Does anyone know, is the max '€10 per item' really per item on the prescrition regardless of the quantity (as in the UK), or is it really €10 per unit? I also take a nasal spray for the hayfever which is 'rezeptpflichtig', and looking at the online chemists, the largest i can find is 140 doses, which will last just over a month. If I get the doc to give me a prescrition for 5 of these (my hayfever usually lasts right through till September, and reagrdless of the cost I don't want to have to go back to the doc every month just to get another prescription), will all 5 be classed as 1 item (costing me €10) or will each one be counted as a separate item?

It's a maximum of 10€ per prescription item regardless of quantity, but I believe physicians can only prescribe one of three package sizes (N1, N2, N3) and some meds (like sprays) only seem to come in N1 size. That being said, there are some (mostly generic) meds that are "Zuzahlungsbefreit" (free of patient copay) because of their relatively low cost. The BKK has a searchable list of such meds on their website (valid for all of the public Kassen): http://www.bkk.de/bkk/show.php3?id=1081&nodeid=1081

My allergy spray, for example, is free of copay (Flutica (fluticasone propianate; brand: Flonase).

You can do a search at an online pharmacy like docmorris.de to determine package sizes available and the copay cost.

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Posted

Thanks. The spray (Nasonex) which I got from the German doc last year (and which worked really well for me) isn't 'Zuzahlungsbefreit', and only seems to come in the N1 size, regardsless of the actual size (number of doses) on the bottle. At €2.50 a time with a kassenrezept on docmorris.de (not used them before, but it's cheaper than the ones i have used, thanks) it's not too expensive, but it will just be a real pain in the ass to have to go to the doc every month get another prescription if they won't give me a prescription for 5 bottles.

In the Uk I just used to go to the doc in the spring and get a prescription for 6 months worth of tablets, spray, eye drops and inhalers to see me right through the summer.

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Posted

If you or the doctor prescrbe stuff that is actually cheaper and available on the free market then the phahrmacist will tell you.

The public health funds are / have moved out of subsidising some mediacal products, maybe anti-histimines is an area - that menas that the point of use cost for the patient increase.

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Posted

I'm confused now - I had a perscription for an injection from the doctor. I took it to the pharmacy and asked how much it was, I showed them I had a TK card and they said it was €33.00,they gave me a receip and said I had to try and claim it back from insurance company - that was how it was done over here.

Should I only have paid €10?

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