Background
Supplementary to the flat rate costs of the German diagnosis-related groups (DRG) reimbursement scheme, co-payment structures and innovation reimbursement structures (NUB) were established in 2005. Uncommon and usually expensive pharmaceuticals, implants and procedures can therefore be appropriately reimbursed in addition to the DRG rate.
Objective
Up to 2015 a total of 170 co-payment structures have been established and introduced supplementary to the German DRG system. This study analyzed the relevance of these additions for hematology and oncology.
Method
Based on the German DRG catalogues for the years 2005–2015 the quantitative and qualitative development of the co-payment structures were analyzed. Relevant improvements in the DRG system for 2015 and unmet needs of the clinical community are presented.
Results
A significant proportion of the co-payment catalogue (45 %) addresses oncological topics. The following focal points could be identified with the number of co-payment structures for 2015 given in brackets: cytostatic drugs (20), monoclonal antibodies (10), blood products (11), oral and other drugs (7), antifungal drugs (10), growth factors (7) and diagnostic and therapeutic procedures (10). Innovation reimbursement structures (NUB) are the entrance portal to the DRG system. Their strategic importance makes them relevant for oncological centers despite the high costs. Of the 30 most frequently requested NUBs, 28 are of oncological relevance.
Conclusions
Co-payment structures and NUBs are essential for inpatient oncology and provide appropriate reimbursement. New challenges, such as price increases for cytostatic drugs and the financing of companion diagnostics have to be met.