Costs of Drugs in connection with adult patients (Germany)?

Question

Please notify that the question/answer is made for a German patient asking about the German medical system!:

My foster daughter has CF and just became 18. Now a pharmacist tells me that health insurance companies do not pay any longer for drugs like Vitamin E and Ambroxol (Ambrohexal) mucus solvent.

Is that correct indeed?

If yes, is there any possibility to take action against that decision? She has no income of her own at all and will never be able to pay herself for the mucus solvents which are vitally important for her.

Answer

Please note that the question/answer is concerning a German patient asking about the German medical system!:

Hello,

Non prescription drugs (over-the counter drugs) are strictly excluded from being paid by health insurances. For patients with CF certain exemptions could be achieved. Nevertheless there are some drugs which are no longer recoverable after the patient is 18 and older.
You can read more about the topic of “over-the- counter drugs” on the website of the Mukoviszidose e.V. www.muko.info/299.0.html [German website]

Here is an excerpt from that source: “On the grounds that there is no knowledge about a human vitamin deficiency disorder in connection with a Vitamin E deficiency unfortunately Vitamin E was not accepted on the list although the Mukoviszidose e.V. intervened again. Thus Vitamin E preparations regrettably are not coverable yet.

Non prescription Mucus solvents ((Ambroxol, Bromhexin, Acetylcystein to be taken with acute symptoms) are no longer coverable, but Acetylcystein to be taken on a long-term basis is available only on prescription and thus recoverable in connection with CF. Please be absolutely careful that appropriate drugs are prescribed:

Acetylcystein preparations available on prescription only are for example: Acemuc 100/-200-600, produced by betapharm; Fluimucil -100/-200 lemonade tablets/ - long; capsules, - 100/-200 granulates). Attention: The additional label “acute” usually indicates that this is a drug for short-term use only, thus a non- prescription drug, thus not coverable.

The use of Acetylcystein in connection with CF is only reasonable in the context of a long term therapy concept which must be supervised by a physician. Thus the prescription of forms of Acetylcysteine which are only available on prescription is medically appropriate and cannot be replaced by the prescription of drugs intended to be used with a common cold.

I hope I could help you with this information.

With kind regards
Dr. Christina Smaczny

10.11.2008