{"id":7427,"date":"2026-02-23T14:49:17","date_gmt":"2026-02-23T13:49:17","guid":{"rendered":"https:\/\/value-dossier.com\/?page_id=7427"},"modified":"2026-04-01T13:52:22","modified_gmt":"2026-04-01T11:52:22","slug":"reference-price-analyses","status":"publish","type":"page","link":"https:\/\/value-dossier.com\/en\/reference-price-analyses\/","title":{"rendered":"Reference Price Analyses"},"content":{"rendered":"\n
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Reference Price Analyses<\/h1>\n <\/div>\n <\/div>\n\n <\/div>\n
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Reference Pricing \u2013 Analysis, Simulation and Strategic Assessment<\/h2>\n

Reference pricing (\u201cFestbetr\u00e4ge\u201d) is a key regulatory instrument used by the German statutory health insurance system<\/strong> to control pharmaceutical expenditure. The legal framework is defined in Section 35 of the German Social Code Book V (SGB V) and Section 130a (3) SGB V. These provisions establish maximum reimbursement amounts for medicinal products within defined comparison groups. Reference prices are generally introduced once medicinal products lose patent protection<\/strong> and generic competition<\/strong> enters the market.<\/p>\n

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Figure 1: Adjustments, determinations and repeals to reference prices between 2020 and 2026 per quarter.<\/p><\/div>\n

Structure of Reference Price Groups<\/h2>\n

Reference price groups are formed in three stages:<\/p>\n

\u2022 Level 1:<\/strong> Medicinal products containing the same active ingredient
\n\u2022 Level 2:<\/strong> Medicinal products with pharmacologically and therapeutically comparable active ingredients
\n\u2022 Level 3:<\/strong> Combinations of active ingredients and therapeutically comparable medicinal products<\/p>\n

Certain exceptions apply, particularly for pediatric medicines<\/strong> and, within Levels 2 and 3, for products that demonstrate a proven therapeutic improvement.<\/strong><\/p>\n

The formation of reference price groups is the responsibility of the Federal Joint Committee (G-BA)<\/strong>. The calculation, adjustment and regular review of the reference prices themselves are carried out by the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband). These calculations are based primarily on current price and product data as well as prescription data from the previous year<\/strong>. Reference price groups may be reviewed annually and adjusted to reflect market developments.<\/p>\n

The reference price defines the maximum reimbursement amount<\/strong> covered by statutory health insurers. If the pharmacy retail price exceeds the reference price, patients must pay the difference as an additional co-payment on top of the statutory co-payment. For medicinal products priced more than 30% below the reference price, the GKV-Spitzenverband may define an exemption from statutory co-payments<\/a>.<\/p>\n

Our Services in the Field of Reference Pricing<\/h2>\n

We support pharmaceutical companies in the quantitative and strategic evaluation of reference-price-related questions \u2014 using data-driven analyses, simulation models and deep regulatory expertise.<\/p>\n

Reference Price Calculator \u2013 Planning Certainty for Your Portfolio<\/h3>\n

Our reference price calculator enables simulation of the impact of reference price regulations on your products \u2014 both for newly established reference price groups and for existing groups.<\/p>\n

For new group formations<\/strong>, we calculate the expected reimbursement level based on the applicable regulatory methodology. This allows you to gain early insights<\/strong> into the potential price level within a future group and to evaluate strategic options in advance.<\/p>\n

For new strengths and package sizes<\/strong>, we will calculate the expected reference price as well as the corresponding maximum retail price you can charge while avoiding an additional co-payment for the patient. We would also be happy to provide an assessment of the likelihood that your product will be classified into a reference price group<\/strong> and advise you on any questions regarding fixed amounts.<\/p>\n

For existing reference price groups, we calculate the expected reference price<\/strong> based on the current price structure and relevant prescription data, as well as the potential cost savings for the statutory health insurance system. These analyses allow you to prepare for potential adjustments at an early stage and to align your pricing strategy accordingly.<\/p>\n <\/div>\n\n <\/div>\n<\/section>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-7427","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/pages\/7427","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/comments?post=7427"}],"version-history":[{"count":12,"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/pages\/7427\/revisions"}],"predecessor-version":[{"id":7861,"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/pages\/7427\/revisions\/7861"}],"wp:attachment":[{"href":"https:\/\/value-dossier.com\/en\/wp-json\/wp\/v2\/media?parent=7427"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}