A pharmacist is a doctor

Fight to reorganize the distribution of tasks between doctor and pharmacist

Berlin. Vaccinating against the flu, analyzing medication, managing medication and recording health parameters such as blood pressure, blood sugar and cholesterol levels could also be tasks for pharmacists.

These possibilities are to be opened up with the law to strengthen the on-site pharmacies. Health Minister Jens Spahn (CDU) wants to give legally and privately insured persons a right to “pharmaceutical services” that goes beyond the existing right to information. Statutory and private insurance will have to raise around 200 million euros in addition a year.

Political differences with the EU

The parliamentary consultation process is currently on hold. Before doing this, the political differences with the EU must be resolved as to whether mail-order pharmacies from other European countries are allowed to compete with local pharmacies with discounts. The Ministry of Health told the "Doctors newspaper" that there is a good exchange of information with the EU Commission. According to media reports, Spahn will short-circuit this week with Internal Market Commissioner Thierry Breton.

The genesis of the draft dates back to 2019. In the first draft of the law, there was literal reference to the collection of “health parameters”. This terminology is still missing in the government draft from 2019. In particular, drug therapy safety is addressed here, especially in the case of chronic diseases and multimorbidity.

From the point of view of the health insurances, a reorganization of the roles and distribution of tasks between doctor and pharmacist is crucial in the course of the introduction of “pharmaceutical services” and their remuneration.

No double remuneration

“A double payment must be avoided”, it says in a joint paper of the BKKen and the IKKen, which are linked in the cooperation group of company-related health insurance funds (kuk). "What we do not want is a mere add-on, and that there is no longer any question of efficiency reserves in the supply of pharmaceuticals," said BKK umbrella association board member Franz Knieps of the "Ärzte Zeitung". An expert opinion commissioned by the Federal Ministry of Economics in 2017 put these reserves at a good 1.2 billion euros, which would be paid too much to pharmacies.

The health insurers therefore want to keep an eye on the competition for new services. "We believe that you can make better use of the pharmacists' expertise and at the same time shift remuneration to those pharmacies that can actually provide the new services," said the managing director of IKK e. V., Jürgen Hohnl.

Documented performance records

In addition, the health insurance representatives demand documented proof of performance, criteria for how often a service must be reimbursed per patient, a definition of what triggers a pharmaceutical service and a consultation room in which the service can be provided protected from the eyes of other customers.

The kuk representatives do not want individual pharmacists to be “detached and lone warriors”. A “structured cooperation” with doctors is necessary. For pharmacists who vaccinated or regulated medication, clear transfer points to the doctor would have to be defined, said Knieps.

In its statement on the legislative plans, the KBV rejected medical replacement services to be provided by pharmacists. (af)