How well-prepared is private health insurance for e-prescriptions?

According to the plans of the German Federal Ministry of Health (BMG), e-prescriptions will be available to people who have statutory health insurance as early as mid-2021. As early as 2022, the use of e-prescriptions will be mandatory throughout Germany, not only for people who have statutory health insurance, but also for drugs which are available only in pharmacies.

What does this mean for private health insurers and their policyholders?

The German Association of Private Health Insurers has been a shareholder in gematik since April 2020 and is working on a connection to the telematics infrastructure (TI) in order to enable e-prescriptions for private health insurance companies in addition to the patient file. Now that this project is underway, it is expected that privately insured individuals will soon be able to enjoy the benefits of electronic prescriptions.

The key here is the technical connection of the individual providers. The technical hub for the more than 500 million prescriptions in Germany is a central special service provided by IBM, which has been commissioned by gematik. This service stores prescriptions in encrypted form. An important data security measure is that the identity provider has been contracted separately, thereby separating the processing of the encrypted data and the authentication of the participants. gematik is currently developing an e-prescription app, which will be available in July 2021. Private health insurers in particular will want to use API integration to expand the functionality existing apps for submitting invoices and other relevant content, so that they do not have to create additional interfaces for interacting with policyholders.

The advantages for the policyholders are obvious: the elimination of the use of paper prescriptions, transparency about the status of prescriptions, the ability to compare databases (e.g., to rule out interactions with other medications), to name just a few.

But what are the advantages and opportunities for insurers?

One important advantage is that there will no longer be any data transmission errors when submitting e-prescriptions. In addition to correct billing, central authentication of all participants involved also eliminates the potential for fraud. This is a desirable feature for insurance companies and policyholders alike.

Until this new standard has become established, the timely integration of e-prescriptions is expected to be a decisive competitive advantage among private health insurers.

Providers will realize potential savings in input management, because it will no longer be necessary to manually reconcile physical prescriptions after they have been scanned in via OCR. This will also save time during these processes, which is not only important in-house, but will also benefit customers, who will be able to make payments more quickly.

In the long term, private insurers should prepare themselves for far-reaching adjustments. Particularly in terms of technical accessibility, benefit systems should be developed to enable policyholders to make inquiries in real-time about reimbursements or even cost absorption. The market may develop to enable privately insured individuals to use an app while still at the pharmacy to find out, depending on their plan, to what extent their private health insurance would cover the costs.

It will be important for privately insured individuals to be able to make their own decisions about reimbursements. A simulated live submission can answer questions such as: is submitting a bill detrimental to a possible premium refund? Has my deductible already been used up?
Better information can help policyholders make an immediate decision. Furthermore, e-prescription with full connectivity to a benefits system, combined with an appropriately advanced app, can also revolutionize payment. In this way, policyholders can also directly settle invoices with the private health insurer.

All in all, e-prescriptions are an opportunity not only for policyholders, but for all participants in the healthcare industry. Physicians, service providers and insurers have much to gain from the high initial outlay involved. The necessary data protection for highly sensitive data and the elimination of processing times and transmission errors allow for greater transparency of each process for all authorized participants.