E-scripts in Germany: background and opportunity

The nationwide and mandatory introduction of e-prescriptions for prescription drugs (Rx) is not just a matter for German law. It is also a real opportunity for the Zur Rose Group and its customers.

Launch of e-prescriptions in progress: test phase successfully completed

The steps involved in using electronic prescriptions (e-prescriptions or eRx) – from issuing and sending them to policyholders to dispensing and invoicing – have been trialled in a nationwide test phase. The quality criteria agreed by all partners of gematik, the National Agency for Digital Medicine, i.e.:

• 30,000 e-prescriptions successfully billed
• 99.9% availability of infrastructure
• A high proportion of PVS/ ZPVS/ AVS systems have already issued e-prescriptions
• All health insurers must be able to accept and invoice e-prescriptions
• Retaxation cases, i.e. partial or full reimbursement of pharmaceutical costs to pharmacies by health insurers for technical reasons, should be virtually zero
• No server errors

were successfully fulfilled on 31 August 2022. The nationwide phased roll-out followed on 1 September 2022. Shortly afterwards, however, the region of Westphalia-Lippe and the federal state of Schleswig-Holstein announced that they would no longer press ahead with the roll-out of e-prescriptions due to the lack of low-threshold digital redemption options. In February 2023, gematik confirmed that – in addition to the hard copy of the prescription code and the e-prescription app – the electronic healthcare card (eGK) is also permitted as a further redemption option. The Federal Ministry of Health (BMG) is also considering allowing patients to scan the e-prescription code (token) from a card reader in a doctor’s surgery using a smartphone and then redeem it at a pharmacy of their choice using an app. According to the BMG, this paperless method could in future be used as an additional option for redeeming e-prescriptions at online pharmacies.

Unique opportunity for the Zur Rose Group

• Digitalisation of the approximately 500 million paper recipes (pRx) issued annually opens up a market worth EUR 50 billion. 80 per cent of this can be counted as chronic demand.
• Currently, paper-based Rx online has a market share in Germany of less than one per cent. With OTC online penetration already at 23 per cent, it is realistic to achieve at least ten per cent of e-prescriptions online in the mid-term. This is particularly evident from a look at other European countries where e-prescriptions are already commonplace: for example, the share of eRx online in Sweden has risen from zero to 13 per cent within just a few years.
• With its number one brand DocMorris, the Zur Rose Group is ideally positioned in Germany. This is also reflected in the aided brand awareness of 65 per cent and the aided e-prescription awareness of 18 per cent. (data as at December 2022)
• According to internal calculations, the existing OTC customers of the Zur Rose Group have e-prescription potential of more than EUR 1 billion: Approximately 26 per cent of active customers belong to the group of people living with one or more chronic diseases.

Digitalisation in healthcare: e-prescriptions setting the course

• E-prescriptions are not only the basis for widespread use of electronic patient records, but also an important enhancement when it comes to the use of telemedicine. Electronic prescriptions are essential for other new digital applications too, such as medication reminders and the e-medication plan including the interaction check. These make an important contribution to adherence and medication safety.

Firm legal basis: the path to the introduction of e-prescriptions with free choice of pharmacy

• On 20 October 2020, the German Protection of Electronic Patient Data in the Telematics Infrastructure Act or Patient Data Protection Act (PDSG) came into force. Originally, it stipulated mandatory and nationwide introduction of e-prescriptions as of 1 January 2022 for prescription drugs. There is nothing to prevent this as soon as the technical requirements have been met.
• Following the amendment to Book 5 of the German Social Security Code (SGB V) on the basis of the PDSG, policyholders are always free to choose their own pharmacy – local or online. According to this, patients should also be able to use their prescriptions conveniently, easily and securely at mail-order and online pharmacies if desired.

Conclusion

One thing is certain: when it comes to digitalisation in the German healthcare system, the introduction of electronic prescriptions is essential. This is because it lays the foundation for structured data processing and the introduction of electronic health records. And the advantages are obvious for the players too: in future, doctors will also be able to send their patients their prescriptions digitally, so it is no longer absolutely necessary to come into the practice each time. For patients, e-prescriptions not only contribute to medication safety and adherence, but are also a convenient, simple and modern solution. Last but not least, practice staff will be relieved in the long-term.