[Immunotherapies in the German healthcare system : Economic aspects of established antibodies and recently available therapies].

In the German healthcare system, immunotherapies have been well established for years. Currently there are over 100 registrations of monoclonal antibodies (MABs). In recent years, new immunotherapeutic approaches became available, amongst them checkpoint inhibitors and CAR‑T cells in oncology. Increasing expenditures of the German statutory health insurance (SHI) system are regarded with concerns. This article presents an overview of the development and status of prescriptions and sales of selected immunotherapeutics in Germany. Data from 2015-2019 were analyzed, primarily from the GKV-Arzneimittel-Schnellinformation (GAmSi) and the consultancy IQVIA.In the group of older MABs, such as immunosuppressive and antineoplastic agents, biosimilars led to a (temporary) increase of applications, but reimbursement amounts are decreasing. Instruments of the SHI system like drug agreements, reference prices, and individual discount contracts intervene as expenditure control. Checkpoint inhibitors clearly show increasing prescriptions and expenditures. Finally, the CAR‑T cells are indeed very expensive treatments, but are currently not that important due to the limited number of applications. In addition, the exemption from VAT of 19% and the signed discount agreements between suppliers and sickness funds reduce the burden. In 2015 and 2019, the net expenditures on drugs and surgical dressings accounted for 17.2% of the total expenditures on benefits of the SHI system. Should the expenditures on drugs increase overproportionately in the future, the German SHI system will be able to counteract with already available or new instruments, supported by the legislator. Manufacturers and the SHI system should develop joint actions to achieve solutions for new treatment approaches.