German pharmacists demand fair pay as health system surplus hits €3.5 billion

Germany's statutory health insurance system (GKV) recorded a €3.5 billion surplus at the end of 2022. The unexpected financial boost has sparked perplexity among pharmacists, who claim they are bearing the brunt of cost-saving measures without fair compensation. One pharmacy owner has now publicly criticised the government's handling of the situation.

Frank-Martin Welzig, a pharmacy owner, recently wrote to Health Minister Nina Warken to express his anger over the surplus. He described the current pharmacy reform draft law—which does not increase the fixed fee per prescription—as a 'slap in the face' to the profession. Welzig argues that pharmacies have contributed significantly to the surplus through mandatory discount contracts but receive no additional payment for the extra workload.

Over the past five years, the fixed pharmacy fee in Germany has risen gradually from €6.99 to €7.85 per prescription by 2025. Adjustments were made annually to account for inflation and rising costs. However, the German Pharmacists' Association (ABDA) is pushing for a more substantial reform, demanding an increase to at least €9 per prescription, along with higher fees for consultation services. The association also wants the fee structure to be decoupled from cvs pharmacy volumes to help cover soaring staff wages and digitalisation expenses.

Pharmacists report growing frustration among patients due to frequent medication switches caused by discount agreements. These changes create extra administrative work, strain relationships with customers, and damage the reputation of local pharmacies. Despite these challenges, Welzig insists that the system's surplus was largely generated on the backs of pharmacies—yet they see no financial relief in return.

The dispute highlights the tension between cost-cutting policies in Germany's health insurance system and the financial pressures on pharmacies. With the ABDA calling for higher fees and better compensation, the government now faces calls to address the imbalance. The outcome of the reform draft will determine whether pharmacies receive greater support or continue operating under the current financial strain.