DiGA prescriptions binding for health insurers
7/14/2023 Digitalisation News

DiGA prescriptions binding for health insurers

The German Medical Technology Association (BVMed) has welcomed the clarification by the Federal Social Security Office (BAS) that medical prescriptions of digital health applications (DiGA) are binding for health insurers. "This is good news for patients and removes the uncertainty prevailing in the market," explains BVMed outpatient expert Juliane Pohl.

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The Federal Office for Social Security (BAS) clarifies in its circular "Review obligations and rights of health insurance funds in the dispensing of digital health applications (DiGA) according to § 33a SGB V" of 16 June 2023 that health insurance funds are not entitled to "switch to other, possibly cheaper DiGA" in the presence of a medical prescription. DiGA are prescribed by doctors on a product-related basis, so it is their responsibility to check whether the services are sufficient, appropriate, necessary, and economical. The circular states that while respecting the doctors' freedom of therapy, the health insurance fund is "fundamentally precluded from interfering with the doctor's decision to prescribe".

The Federal Office refers to the legal regulation on the product-related prescription of a DiGA, the determination of the DiGA price system at the level of the umbrella association and the list kept as a positive list at the BfArM. This had created an exception to the principle that the provision of a benefit in kind is dependent on the prior determination of the health insurance fund's obligation to provide benefits, i.e., an authorisation.
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