Aut-idem substitution

Pharmacies are obliged to dispense low-priced drugs that are "aut-idem-compliant" in relation to the prescribed drug. The framework agreement regulates in § 9 the details of the conditions of an aut-idem substitution. Accordingly, the pharmacy must select a low-priced drug if the physician has either only prescribed the drug by means of the name of the active ingredient or if the physician has prescribed a specific drug but has not prevented the substitution by means of an aut-idem cross.

The following requirements must be met by an aut idem-compliant alternative preparation:

• same active ingredient
• identical potency
• identical package size according to § 8 of the framework agreement
• Identical or interchangeable dosage form
• Approval for the same field of application
• no narcotics legislation contrary to the exchange

Discount medicines must be given preference. Non-dispensing of a discount drug (e.g. in emergency service, in acute cases, due to pharmaceutical concerns or delivery difficulties) must be documented on the prescription in accordance with the contractual regulations.

If it is not possible to dispense a discount drug, one of the four least expensive aut-idem-compliant drugs must be dispensed. This also applies to an active ingredient prescription. If a named prescribed drug is already one of the four least expensive drugs, the drug to be dispensed may not be more expensive than this (price anchor). The price comparison is based on the price adjusted for statutory discounts (§ 12 Framework Agreement).