Berlin – November 03, 2026 -- The Scientific Institute of the AOK (WIdO) expects net drug costs in Germany's statutory health insurance (GKV) to rise 2.2% to 2.8% in 2027, a sharp slowdown from the 5.5% growth projected for 2026. The brake comes from the GKV Contribution Rate Stabilisation Act (GKV-BStabG), whose additional manufacturer discount is meant to relieve payers by almost EUR 2.5 billion. WIdO says the structural drivers of spending remain untouched.
Extra 8.5% discount lifts total rebate on patented drugs to 15.5% from January 2027
From January 2027, large parts of the patent-protected market face an additional 8.5% discount on top of the general 7% manufacturer rebate. The affected products would carry a combined discount of 15.5%. WIdO managing director Helmut Schröder said the measure slows spending only temporarily and does not guarantee a lower long-term growth rate. He argued that new high-priced therapies, additional indications and larger treated patient groups will keep pushing costs up.
Location clause leaves the size of the relief uncertain
Manufacturers can qualify for a location rebate if they run a certain share of their clinical trials in Germany. Research, development and production activities are also to be considered, and companies could receive partial or full exemption from the additional discounts. The broader the exemptions, the smaller the savings for the GKV. How the exemptions would be financed is unresolved. Schröder said industrial-policy exemptions must not leave contributors, employers and the pension insurance with an open bill.
Patented drugs account for 55% of 2025 net costs but 7% of doses
Net costs of outpatient drug supply hit a record EUR 62.6 billion in 2025, up 5.6% on 2024. Prescribed daily doses rose only about 1% to 50.3 billion, and the number of prescriptions dipped slightly. Patent-protected drugs generated EUR 34.4 billion, about 55% of net costs, while making up just over 7% of daily doses. Net costs in that segment rose 7.6% year on year.
Oncology and immunotherapy drugs together caused about 37.6% of net costs but just under 3% of daily doses. Cardiovascular drugs made up 50.6% of daily doses and only 14.3% of costs, as generic competition, reference prices and rebate contracts limit prices there.
First-half 2026 drug costs rise 5.4% to EUR 32.5 billion
In the first six months of 2026, net drug costs grew 5.4%, or about EUR 1.6 billion, to EUR 32.5 billion. Total GKV benefit spending rose 7.4%, while contribution-liable income grew only 4.1%. WIdO projects full-year 2026 net costs to climb about 5.5%.
Rebate contracts save EUR 6.8 billion, but biosimilar tenders are frozen until July 2028
Savings from rebate contracts reached a record of about EUR 6.8 billion in 2025, yet their share of drug spending has held at roughly 10% for years. The number of active substances in the biosimilar-eligible market has quadrupled since 2016, but total spending in the segment kept rising on higher prescription volumes and market mix. WIdO says price reductions seen in other European countries would require exclusive rebate contracts with a single winning manufacturer, as already used for generics. Lawmakers suspended these until July 2028, so the savings potential stays unused until then.
US most-favored-nation policy adds pressure on European pricing
The US most-favored-nation approach ties American prices to lower prices in comparable industrialised countries. The US government explicitly expects prices to rise in other wealthy nations. WIdO says this sharpens the conflict in Germany between manufacturers' international pricing strategies and the affordability of care. Schröder called for GKV payments to be tied to a drug's additional patient benefit.