Drying room

Germany: PrEP Covered by The Statutory Health Insurances (September 2019)

The statutory health insurance funds in the Federal Republic of Germany will pay for the medically prescribed HIV pre-exposure prophylaxis – PrEP – from 1 September 2019.

# What’s new for statutory insured persons in Germany?

From September 2019 on in the Federal Republic of Germany costs for PrEP will be paid for statutory health insured persons. This enables legal General Practitioners to accompany, describe and settle up costs for PrEP.

This option is given (from the age of 16 years on) if you are a person with a higher HIV-risk of transmission which has to be checked in a personal talk with your doctor. For instance you are carrying that risk if you´re a man who´s likey to have sex with other men, if you are a transperson, an intravenous drug user as well as persons with permanent partners who are HIV positive and not “undetectable”. Heteros and lesbian women are not at high risk by having various sex partners. They need other reasons in order to get a free description (e.g. sex workers).

The costs of medical support goes toward a certain number of laboratory examinations per year and the prescription of appropriate preparations can now be billed (settlement key GOP 01920 to 01922: • consultation before the start of PrEP • initiation of PrEP: indication [i.e. the clarification if all criteria for prescribing are met], HIV and HBV test, drug prescription • PrEP control). PrEP preparations must be prescribed on statutory health insurance prescription (and not as before as private prescription). This receipt can then be easily redeemed in the pharmacy. A surcharge of around 5 EUR is due at Pharmacies (inc. online Pharmacies), unless you make an online application for a prescription redeeming form with your health insurance.

It is stipulated that personal medical contact (visits and discussions in practice) is necessary to carry out a PrEP. Furthermore, concomitant STI tests can also be billed on a regular basis, regularly for hepatitis B and C or for individual, situational risk assessment for syphilis or chlamydia. It will also cover the costs of laboratory tests to control kidney performance (Creatine determination) and regular HIV testing to verify the success of PrEP.

The new regulations only affect PrEP when taken daily. The intake “on demand” (in phases only at times when there is a particular risk of infection, remains off-label use, e.g outside the actual approval for the drug (prescription at risk of the doctor). This means that for on-demand PrEP, no costs will be borne by the statutory funds and (officially) only the daily PrEP can be prescribed.

At the moment PrEP is new territory for many GP surgeries. However, your doctor can familiarise themselves with the matter relatively fast based on existing guidelines and obtain the authorisation to prescribe PrEP. If you are uncertain about this, you can visit a focus practice or go to a checkpoint (e.g Berlin) and access PrEP there. You do not need a referral to visit there. Settlements with health insurance companies can be problematic in the beginning, but PrEP will soon become routine and thus uncomplicated.

# Not statutory insured in Germany?

Those that are privately insured will not profit from the new regulations of health insurance carrying costs. Private insurance can refund costs if they want to. The future will show how private insurances will act concerning this subject. If you are a privately insured person and interested in starting a PrEP you should always check with your insurance first.

PrEP can still be described via a private prescription. The costs for a monthly package varies between 40 to 70 euros in pharmacies. Maybe there are cheaper online offers (link in German). This is the only way people without any health insurance can participate in PrEP.

If you are based in Switzerland or Austria you can get the PrEP medication only through a private prescription. You can find detailed information about that in German: PrEP in Austria | PrEP Yourself in Switzerland.

# Pass the info on!

We gladly welcome the fact that in Germany PrEP is now part of the statutory health insurance benefits for insured persons. (The new regulations are undoubtedly a result and success of PrEP activist work in the past three years.) Now even those who could not afford to do so, can freely choose PrEP and effectively protect themselves. If you know someone who may benefit, feel free to tell him or her about this new policy!

# Sources and more info (in German)

You’ll find everything you need to know about PrEP in our leaflet “Ready for PrEP!”

© lovelazers 2019. photo “drying room” by whit forrester 2016.