In addition to medicines, bandages and medical devices as well as aids, “other pharmacy goods (Section 1a Paragraph 10 of the Pharmacy Operating Regulations)” can also be prescribed – this means that the services in this regard exceed those of the GKV.
When it comes to additional costs, the drug supply contract also provides for its own regulation in Section 5 Paragraph 6:
“If a fixed amount is set for the product dispensed in accordance with § 35 or 36 SGB V and the pharmacy dispensing price is higher than the fixed amount set for this product, the accident insurance provider is only to be billed for the fixed amount, subject to the provisions of sentence 2, and the additional amount is to be invoiced by the insured person to accomplish. This does not apply if the doctor points out the medical necessity of the more expensive drug on the prescription sheet; In this case, the accident insurance provider must be billed for the pharmacy retail price, regardless of the fixed amount regulation in accordance with Sections 29 and 31 SGB VII. For example, placing the aut-idem cross can be seen as an indication of medical necessity.”
Function of the Aut-idem Cross
This means that additional costs that normally arise with BG prescriptions also have to be paid by the patients. However, the prescriber is given the opportunity to emphasize the medical necessity of the more expensive drug and, in this case, to instruct the billing to be borne by the statutory accident insurance provider. The setting of the Aut-idem cross is expressly mentioned for this purpose.
On the basis of this agreement, the retaxation presented above must be withdrawn – the Aut idem cross was placed here by the doctor and thus, as previously quoted, underscored the necessity of the prescribed Yomogi capsules. The pharmacy should be able to assume that the additional costs can be billed to the statutory accident insurance provider and can object to the reduction.
