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In this paper we examine different forms of a 4th hurdle for the reimbursement of pharmaceuticals, i.e. an economic evaluation of the cost-effectiveness of pharmaceuticals. This instrument is aimed to organize the decision on the reimbursement of pharmaceuticals more efficiently than it is currently the case in the German health care system where the market authorization of the product is normally sufficient for a product to be included into the benefits catalogue. Also the arrangement of the reimbursement price is economically problematic. Obviously, the way the instrument is designed is of paramount importance for the efficiency of a 4th hurdle. There are a lot of variations imaginable which yield very different results. In addition, the usefulness of the 4th hurdle must be assessed before the background of relevant politically enforceable alternatives. In this respect a properly arranged 4th hurdle is an improvement compared to the status quo. Indeed, it is for sure not the best conceivable regulation design for a liberalized pharmaceutical market in a statutory health insurance system.

Ausgestaltungsvarianten und ökonomische Konsequenzen einer 4. Hürde für die Erstattung von Arzneimitteln