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Extra payment for medication: fixed amount and additional costs

At the pharmacy checkout, amounts often add up that go beyond the normal co-payment. This is due to fixed amounts and rebate contracts. Anyone who knows the rules can avoid unnecessary extra payments.

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Your chances of getting your money back

For many medicines there are fixed amounts: up to this amount the fund pays, costs going beyond it are borne by the insured (§ 31, § 35 SGB V). To be distinguished from this is the statutory co-payment per package.
If the doctor prescribes a medicine with the same active ingredient within the fixed amount or a rebate contract, no extra payment applies. In case of exemption from co-payments, the statutory co-payment also does not apply.

What you should do now

  1. 1

    1. Discuss the prescription

    Ask the doctor for a fixed-amount-eligible or rebate-contract medicine.

  2. 2

    2. Ask the pharmacy

    Inquire at the pharmacy about an extra-payment-free alternative.

  3. 3

    3. Check exemption

    Check whether you are exempt from co-payments due to exceeding the burden limit.

  4. 4

    4. Collect evidence

    Keep receipts in order to prove the burden limit.

How to spot the scam

  • You pay extra payments although there are extra-payment-free alternatives.
  • A possible co-payment exemption is not used.
  • Fixed amount and co-payment are confused.

Frequently asked questions

Why do I have to pay extra for medication?

If the price of the medication is above the fund's fixed amount, you bear the difference yourself (§ 35 SGB V). That is the extra payment. It is not the same as the statutory co-payment, which applies per package.

How do I avoid the extra payment?

By having a medicine with the same active ingredient within the fixed amount or a rebate-contract medicine prescribed and dispensed. Raise this with the doctor and pharmacy; there is often a medically equivalent alternative without an extra payment.

Can I be exempted from co-payments?

Yes. If your co-payments in the year exceed the burden limit (generally two percent of gross income, one percent for the chronically ill), you can be exempted for the rest of the year. Collect all receipts for this.

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General information for self-help, not legal advice (RDG). In case of a high loss or uncertainty: contact a consumer advice center or a lawyer.