Health ministry · Medicines
Medicines: affordable, innovative and actually on the shelf?
German pharmaceutical policy pursues three goals that pull against each other: keep spending under control, reward new treatments, and make sure the everyday medicines are there when a patient needs them.
- GKV drug spending
- ≈€58.3bn, 2025 (+5.7%) · vdek / BMG data
- Shortage reports
- 1,514 reports, 1,041 shortages, 2025 · Zi / BfArM
- Manufacturer discount
- 15.5% from 2027 · GKV-BStabG
- Community pharmacies
- 16,601, end 2025 · ABDA
Six stations from molecule to patient
Most shortages begin far upstream, often outside Europe. Prices are set downstream, in Germany. The chain explains why national levers reach only part of the problem.
The medicine supply chain and its control points
SourceEditorial schematic based on the Medicinal Products Act, SGB V, the ALBVVG (BfArM) and the Critical Medicines Act proposal. Simplified; hospital supply follows a different route.
02 / Availability
Shortages as a routine condition
A reported supply shortage does not always mean that patients go without: often another pack size, another manufacturer or a substitute with the same active ingredient is available, and pharmacists spend considerable time finding one. But shortages of antibiotics and children’s medicines in the winter of 2022/23 turned the issue into a political priority.
The response was the Act to Combat Supply Shortages of Off-Patent Medicines (ALBVVG), in force since 27 July 2023. It gives the BfArM an early-warning system to identify supply-relevant concentrations in the market for off-patent active ingredients, requires a monthly list of essential medicines for children up to twelve, allows pharmacies to switch dosage forms or prepare alternatives for listed children’s medicines without consulting the doctor, and strengthens the advisory council on supply shortages. It also eased price rules for children’s medicines and introduced stock-keeping requirements in insurers’ discount contracts. In force · inherited
The pharmacy reform of 2026 adds a further flexibility: pharmacies may dispense an available product when the medicine covered by a discount contract cannot be supplied, without facing claw-backs from insurers. In force · inherited
The structural causes lie further upstream. Generic medicines in Germany are bought at very low prices through fixed reference prices and discount contracts; production of many active ingredients has concentrated in a small number of plants, often in Asia. When one plant fails, supply can falter across Europe. This is why the EU’s Critical Medicines Act — provisionally agreed on 12 May 2026, formal adoption pending — targets procurement rules and EU production capacity. EU · pending The crisis dimension is covered on the health-security page.
How Germany pays for medicines
Two very different markets share one budget: patent-protected innovation and low-cost generics.
Selected pharmaceutical figures in statutory health insurance
Sourcevdek data page based on BMG statistics (spending level; other reports give €58.5bn); Federal Ministry of Health, GKV results 2025 (increase of 5.9%); GKV-Spitzenverband via Deutsches Ärzteblatt (AMNOG savings, insurers’ estimate).
New medicines — AMNOG. Since 2011, the Act on the Reform of the Market for Medicinal Products (AMNOG) has required a benefit assessment for every new active ingredient. The Federal Joint Committee (G-BA) decides on the added benefit, usually based on an IQWiG assessment; the GKV-Spitzenverband and the manufacturer then negotiate a reimbursement price that applies after the first months on the market. The industry association vfa counts more than 1,030 procedures for 464 new medicines between 2011 and 2024. The insurers estimate that negotiated prices saved about €10.3 billion in 2024.
Generics. For off-patent medicines, fixed reference prices cap what insurers pay, and individual insurers sign discount contracts with manufacturers. The system is cheap — and, critics argue since the 2022/23 shortages, too cheap to reward reliable supply.
The manufacturer discount. Manufacturers grant a statutory discount to insurers. The contribution-stabilisation law passed on 10 July 2026 replaced a planned dynamic discount with a fixed increase of the static discount to 15.5% from 2027, raised the extra discount on patented vaccines to 9% and imposed a price moratorium on vaccines from 2027 to 2030. In force · inherited
Confidential prices. The Medical Research Act of 2024 allowed companies with research in Germany to keep negotiated reimbursement prices confidential; after criticism, the option was limited until the end of June 2028, with an evaluation planned by the end of 2026. Evaluation due See health innovation.
Affordability · Innovation · Supply security
Every pharmaceutical measure moves the system towards one corner and away from another. The question is which trade-offs a government accepts.
A
Affordability
Drug spending rose 5.9% in 2025, faster than contribution income. Linnemann’s second guiding principle is to avoid ever-higher non-wage labour costs. Higher manufacturer discounts and price moratoria serve this goal.
Pulls against innovation: lower expected returns may delay launches in Germany. Pulls against supply: low generic prices discourage reliable, diversified production.
B
Innovation
Germany is one of the first markets where new medicines become available after EU authorisation. Faster clinical-trial approval and confidential prices were designed to keep research and production in the country.
Pulls against affordability: high-priced new therapies take a growing share of spending. Pulls against supply: investment flows to patented products rather than old generics.
C
Supply security
Stockpiles, diversified sourcing and European production make supply more robust — and more expensive. The ALBVVG and the Critical Medicines Act move in this direction.
Pulls against affordability: someone pays for buffers and higher generic prices. Pulls against innovation: public money for old products is not available for new ones.
No instrument serves all three goals at once. Pharmaceutical policy is the art of choosing which corner to give up.
Editorial noteThe statement above is this site’s analysis. Linnemann has not published a pharmaceutical strategy; the measures in force were decided before he took office.
The pharmacy reform and the mail-order question
The last link in the chain is under economic pressure — and the subject of Linnemann’s most specific pharmaceutical remarks so far.
The number of community pharmacies fell to 16,601 at the end of 2025, 440 fewer than a year earlier, with 502 closures against 62 openings (ABDA, as reported). The Pharmacy Supply Development Act (ApoVWG), prepared under Nina Warken, passed the Bundestag on 22 May 2026 and the Bundesrat on 12 June 2026. It nearly doubles the premium for night and weekend services, eases branch pharmacies in rural areas, lets experienced pharmacy technicians run a pharmacy temporarily, expands vaccination and testing in pharmacies, and allows pharmacists to dispense certain prescription medicines without a prescription in defined urgent cases — the conditions to be specified within a year. In force · inherited
At the German Pharmacists’ Day in Munich (15–17 September 2026) Linnemann gave the opening welcome address. He criticised the practice of foreign mail-order pharmacies offering patients waivers of the statutory co-payment on prescription medicines — something German pharmacies are not allowed to do — and described it as a distortion of competition that should be stopped. He also called for a stronger role for pharmacies in guiding patients. Political position
Germany has since asked the European Union to examine competitive disadvantages in mail order, according to Pharmazeutische Zeitung. Because mail-order pharmacies based in other EU states are protected by the free movement of goods, the issue cannot be settled by German law alone. Under review · EU
„Entweder dürfen es beide oder keiner.“
ContextSupporters of mail order argue that it offers convenience and lower prices for chronically ill patients; local pharmacies argue that unequal rules undermine the night services and personal advice that only local pharmacies provide.
Status of the main instruments
As of 8 October 2026.
AMNOG benefit assessment and price negotiation
Inherited core of German drug pricing. Repeatedly adjusted, most recently by the 2022 GKV financial stabilisation law. No new AMNOG reform has been announced by Linnemann.
Manufacturer discount 15.5% from 2027
Part of the GKV contribution-stabilisation law (Bundestag and Bundesrat, 10 July 2026), which aims at relief of about €19 billion in 2027.
Further savings law (“Spargesetz 2”)
Announced at the government question time of 23 September 2026 to finance new commitments while keeping 2027 contribution rates stable. Whether it includes pharmaceutical measures was not public as of 8 October 2026. See health financing.
EU pharmaceutical package
Political agreement between Parliament and Council on 11 December 2025; endorsed by member states’ ambassadors on 6 March 2026 and by the Parliament’s health committee on 18 March 2026. According to legal analyses it sets eight years of regulatory data protection with a shorter market-protection period than before, and new obligations on supply and shortage prevention. Publication in the Official Journal is pending.
Critical Medicines Act
Provisional agreement on 12 May 2026; procurement criteria favouring diversified and EU-based supply for critical medicines.
Equal rules for mail order
Linnemann’s stated position at the Pharmacists’ Day, followed by a German request for an EU examination. No legislative proposal.
Sources & further reading
- vdek — Drug spending in statutory health insurance
- Federal Ministry of Health — GKV financial results 2025 (10 Mar 2026)
- Zi — Supply shortages 2025 (BfArM data) (Jan 2026)
- BfArM — Supply-shortage database (live)
- BfArM — ALBVVG
- vfa — AMNOG fact sheet (industry source)
- Deutsches Ärzteblatt — GKV-Spitzenverband on AMNOG savings
- Federal Ministry of Health — Bundestag passes GKV contribution-stabilisation law (10 Jul 2026)
- German Bundestag — hib 481/2024 on confidential reimbursement prices (3 Jul 2024)
- Federal Ministry of Health — Bundestag passes pharmacy reform (22 May 2026)
- Apotheken Umschau — Pharmacy numbers at a new low (ABDA data)
- Pharmazeutische Zeitung — Linnemann at the German Pharmacists’ Day (Sep 2026)
- Deutsche Apotheker Zeitung — Mein liebes Tagebuch (20 Sep 2026)
- Pharmazeutische Zeitung — EU to examine competitive disadvantages in mail order
- apotheke adhoc — Linnemann plans “Spargesetz 2”
- Setterwalls — The EU pharma package: how close is it to becoming law? (22 May 2026)
- Alzheimer Europe — EU institutions conclude trilogue on pharmaceutical legislation
- Council of the EU — Critical Medicines Act