On July 10, 2026, the German Bundestag passed the Act on the Stabilization of Contribution Rates in Statutory Health Insurance – the so-called GKV Contribution Rate Stabilization Act. Among the measures directly noticeable to insured persons is the increase in statutory co-payments. For medicines, the minimum amount is to rise from the previous 5.00 euros to 7.50 euros, and the maximum amount from 10.00 euros to 15.00 euros. The percentage calculation rule of ten percent of the retail price remains in effect.

Legally, however, a distinction must be made between a law passed by the Bundestag and existing law. On July 10, 2026, the law had not yet been promulgated. Until the legislative process is completed and the law is published in the Federal Law Gazette, the previous co-payment regulation therefore remains in force. According to the version passed by the Bundestag, the amendment to Section 61 SGB V is to come into force on January 1, 2027.

Separate from this is the increase in pharmacy fees. This change has already been promulgated in the Federal Law Gazette and is therefore legally binding. The fixed pharmacy fee per dispensed package was increased from 8.35 euros to 9.00 euros net on July 1, 2026. On January 1, 2027, it will rise to 9.50 euros net in a second step.

Thus, at the turn of the year, two regulations coincide that must not be confused legally and economically: the increase in pharmacy fees changes the pharmacy retail price. The increase in co-payment, on the other hand, changes the share that the statutorily insured person has to bear themselves. The patient's out-of-pocket share therefore increases much more significantly than the price of the medicine.

Why Ibuprofen 600 mg is prescription-only

The prescription requirement is governed by Section 48 of the German Medicines Act in conjunction with the Medicinal Products Prescription Ordinance and its Annex 1. Ibuprofen is generally subject to prescription. Exempt under certain conditions are, in particular, oral preparations with a maximum of 400 mg of ibuprofen per dosage unit and a maximum daily dose of 1,200 mg for the treatment of mild to moderate pain and fever. A tablet with 600 mg of ibuprofen does not fall under this exception.

The preparation considered here, Ibuprofen AbZ 600 mg, 50 film-coated tablets, PZN 01016109, is therefore prescription-only. It cannot be purchased regularly like an over-the-counter painkiller, but generally requires a medical prescription.

The price of medicine is not freely set by the pharmacy

For prescription-only finished medicinal products, the pharmacy cannot determine the selling price at its own economic discretion. Section 78 AMG generally requires a uniform pharmacy retail price. The specific pricing is governed by the Medicinal Product Price Ordinance.

The pharmacy retail price is simplified composed of the following components:

• the manufacturer's selling price,
• the legally regulated wholesale surcharge,
• the percentage pharmacy surcharge of three percent,
• the fixed pharmacy surcharge per package,
• 21 cents for financing the pharmacy emergency service,
• 20 cents for financing additional pharmaceutical services,
• as well as the statutory value added tax.

According to Section 2 AMPreisV, the wholesaler may charge a fixed surcharge of 73 cents in addition to a percentage surcharge of no more than 3.15 percent, which is capped at 37.80 euros. For pharmacies, Section 3 AMPreisV currently stipulates a percentage surcharge of three percent and the fixed package fee of 9.00 euros, which has been in effect since July 1, 2026.

The increase of the fixed package fee to 9.50 euros on January 1, 2027, therefore does not mean that the pharmacy would be allowed to increase the price of the medicine by any arbitrary amount on its own. Rather, the price changes due to a legally specified calculation component.

Specific calculation using the example of Ibuprofen AbZ 600 mg

For the package with 50 film-coated tablets and PZN 01016109, a pharmacy retail price of 14.48 Euros is shown for the legal and price status as of July 10, 2026. The statutory co-payment is 5.00 Euros; an additional fixed deductible is currently indicated as 0.00 Euros for this product.

For the following calculation, it is exclusively assumed that

• the manufacturer's selling price remains unchanged,
• the other price components do not change,
• no additional fixed costs arise, and
• the insured person is not exempt from co-payment.

This is therefore not a price forecast, but the mathematical application of the already announced amendment to the Medicinal Product Price Ordinance to an unchanged initial price.

Under these conditions, the pharmacy retail price increases from 14.48 euros to 15.08 euros. The sole cause is the increase of the fixed pharmacy fee by 0.50 euros net, or 0.595 euros including VAT. The statutory co-payment, however, rises from 5.00 euros to 7.50 euros. This corresponds to an increase of exactly 50 percent. The price of the medicine, in the same example, only increases by about 4.1 percent. The additional burden on the patient is therefore not primarily due to an increase in the price of the medicine. It mainly results from the politically decided increase of the statutory minimum amount.

The ten percent rule is practically insignificant for inexpensive medicines

At first glance, Section 61 SGB V gives the impression of a proportional co-payment: insured persons pay ten percent of the retail price. In reality, this rule is superseded by minimum and maximum amounts.

Under current law, insured persons pay:

• for drug prices up to 5.00 euros, at most the actual price,
• for prices between 5.00 euros and 50.00 euros, regularly 5.00 euros,
• for prices between 50.00 euros and 100.00 euros, ten percent,
• from a price of 100.00 euros, a maximum of 10.00 euros.

According to the new regulation adopted by the Bundestag, these limits will shift:

• for prices under 7.50 euros, payment remains limited to the actual price,
• for prices between 7.50 euros and 75.00 euros, the co-payment is regularly 7.50 euros,
• between 75.00 euros and 150.00 euros, ten percent is charged,
• from 150.00 euros, the maximum amount of 15.00 euros generally applies.

For the Ibuprofen preparation under consideration, ten percent of the retail price is only 1.45 euros, or about 1.51 euros after the fee change. Both amounts are well below the legal minimum. Therefore, only the minimum amount is decisive.

The burden disproportionately affects inexpensive medications

At the current retail price of 14.48 euros, the co-payment of 5.00 euros corresponds to approximately 34.5 percent of the drug price. With a retail price of 15.08 euros and a co-payment of 7.50 euros, this share increases to approximately 49.7 percent. The patient thus theoretically bears almost half of the indicated pharmacy retail price themselves. Especially for inexpensive generics, the actual burden therefore deviates significantly from the ten percent system still legally mentioned. The minimum amount acts like a flat-rate deductible per package and not like a percentage participation based on the actual value of the drug.

This effect is relevant under social law. The amount of the co-payment is determined neither by the severity of the illness nor by the medical importance of the medicine. Personal income is also initially not taken into account when dispensing in the pharmacy. The financial capacity of the insured person is only included via the annual burden limit according to Section 62 SGB V.

Chronically ill patients and those with regular medication needs are particularly affected

The co-payment is generally levied for each dispensed package. Therefore, those who, due to a chronic illness, permanently require several prescription medicines will more quickly reach a significant cumulative out-of-pocket burden. The federal government justifies the increase by stating that co-payment amounts have largely remained unchanged since 2004 and must be adjusted to general price and wage developments. According to the legislator's calculations, the higher co-payments are expected to relieve statutory health insurance by approximately 1.9 billion euros in 2027. The financial effect arises symmetrically through additional payments from insured persons.

From the perspective of the individual patient, it is crucial that the additional burden arises immediately when a medically necessary service is utilized. The financing is thus shifted from the collectively financed insurance system to the sick insured person to this extent. Unlike a general health insurance contribution, the co-payment does not affect all members in accordance with their income subject to contributions. It burdens exclusively those who actually need medicines, remedies, or other services subject to co-payment.

The burden limit does not prevent every short-term additional burden

According to Section 62 SGB V, insured persons generally only have to bear co-payments up to two percent of their annual gross income for subsistence within a calendar year. For severely chronically ill persons, a limit of one percent applies under the legal conditions. However, this limit does not automatically mean that the pharmacy does not demand a co-payment from the beginning of the year. Insured persons must prove that they have reached the burden limit to their health insurance company and apply for an exemption. Only after the exemption notice has been issued will the co-payment be waived for the remaining part of the calendar year. The burden limit therefore limits the annual total burden. However, it does not eliminate the ongoing liquidity burden that can arise, especially at the beginning of a calendar year.

Co-payment and fixed amount additional costs are not the same

A possible additional payment due to exceeding the fixed amount must be distinguished from the statutory co-payment. For certain groups of medicines, the GKV-Spitzenverband sets fixed amounts. If the insured person chooses a medicine whose price is above the reimbursable fixed amount, they generally have to bear the difference in addition to the statutory co-payment. For the product under consideration, no additional deductible is shown as of July 10, 2026. Whether this will remain unchanged as of January 1, 2027, cannot be definitively determined today, as the fixed amount then applicable and the actual product data are decisive for this. The possible fixed amount difference should therefore not be included in a supposedly secure future total payment. Under the described conditions, only the statutory co-payment of 7.50 euros is legally and reliably calculable.

In which cases no or a lower co-payment is due

The increase does not apply to every insured person and every medication dispensed without exception. Children and adolescents who have not yet reached the age of 18 are generally exempt from the statutory co-payment for medicines. Insured persons with a valid exemption certificate according to Section 62 SGB V also do not have to make any further statutory co-payments. Furthermore, the GKV-Spitzenverband can exempt particularly inexpensive medicines from co-payment under the conditions of Section 31 (3) sentence 4 SGB V. A prerequisite is, in particular, a sufficient price difference to the fixed amount and an expected saving resulting from this. Health insurance companies can also reduce or cancel co-payments for certain rebate agreement medicines. However, for a private prescription or a pure self-payer service, the statutory co-payment according to Section 61 SGB V does not apply. In this case, the patient generally bears the full pharmacy retail price.

Legal assessment

The planned new regulation is formally not an increase in the price of medicine, but an increase in the statutory co-payment. This distinction is essential.

The example of Ibuprofen AbZ 600 mg shows: with an unchanged manufacturer price, the price of the medicine increases by approximately 0.60 euros as a result of the second fee step. The co-payment simultaneously increases by 2.50 euros. The additional patient burden is thus more than four times higher than the price-related increase in the price of the medicine.

The co-payment increases by 50 percent, while the considered pharmacy dispensing price increases by only about 4.1 percent. A statement that the higher co-payment merely reflects a correspondingly increased drug price would be factually incorrect for this example. The burden is particularly evident for inexpensive medicines. The lower the dispensing price is within the minimum co-payment range, the larger the percentage that the insured person pays themselves. The minimum amount thus leads to a regressive burden: for inexpensive preparations, the co-payment weighs significantly more heavily in relation to the drug price than for high-priced medicines, where the maximum amount applies.

Conclusion

The proposed increase in drug co-payments is not a mere technical adjustment. It changes the financial distribution of burdens between statutory health insurance and the insured. For the specific example of Ibuprofen AbZ 600 mg, 50 film-coated tablets, assuming unchanged manufacturer and other price components, the following applies:

• The pharmacy dispensing price increases from 14.48 Euros to a calculated 15.08 Euros as a result of the already announced fee increase.
• The statutory co-payment increases from 5.00 Euros to 7.50 Euros according to the new regulation passed by the Bundestag.
• The co-payment thus increases by 2.50 Euros or 50 percent.
• In contrast, the drug price increases by only about 0.60 Euros or 4.1 percent.
• The share of the co-payment in the pharmacy dispensing price increases from about 34.5 percent to about 49.7 percent.

The actual additional burden on the patient is therefore not the result of a comparable price increase of the medication. It is predominantly based on a legally mandated higher co-payment.

Editorial note: The increase of the pharmacy fixed fee to 9.50 Euros on January 1, 2027, has already been announced. The change in co-payment limits was decided by the Bundestag on July 10, 2026, but had not yet been published in the Federal Law Gazette at that time. The article is to be updated editorially upon conclusion of the legislative process and after publication.