OBJECTIVE: Due to the aut-idem regulation pharmacies are obligated to substitute medications within the statutory health insurance system to low-priced generics or to dispense the prescribed drug (if only a compound is prescribed low-priced generics have to be dispensed). Since April 1st, 2007 pharmacies have to replace non-rebated by rebated drugs. We aimed to investigate if the prescribing of compounds and substitutions in pharmacies has changed after the introduction of rebate contracts. METHODS: We used claims data of the Gmunder ErsatzKasse (GEK) and drew 3 random samples of 1,000 relevant prescriptions each in October 2006, 2007 and 2008. After that, all relevant original prescriptions were screened. RESULTS: Between October in 2006, 2007 and 2008, we observed no change in prescribing compounds only (6.0 %; 7.7 %; 6.8 %; p = 0.47). Prescribing compounds was associated with, e. g. dentists, small packages (N1 vs. N3) and antiinfectives. We found a considerable increase in medications that were substituted in pharmacies (2006: 11.3 %; 2007: 29.1 %; 2008: 39.2 %; p <0.0001). CONCLUSION: Only through the introduction of rebate contracts an increasing amount of substituted medications took place in pharmacies. Before that, the aut-idem regulation had no considerable regulatory effect.
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机译：目的：由于前瞻性法规的约束，药房有义务在法定健康保险体系内将药物替换为低价仿制药或分配处方药（如果仅需处方一种化合物，则必须分配低价仿制药）。自2007年4月1日起，药房必须用退税药品代替未退税的药品。我们的目的是调查引入回扣合同后，药房中化合物和替代品的处方是否已更改。方法：我们使用了Gmunder ErsatzKasse（GEK）的索赔数据，并分别在2006年10月，2007年和2008年10月抽取了3个随机样本，每个样本有1000个相关处方。之后，筛选了所有相关原始处方。结果：在2006年，2007年和2008年10月之间，我们仅观察到处方化合物没有变化（6.0％; 7.7％; 6.8％; p = 0.47）。处方化合物与例如G。牙医，小包装（N1对N3）和抗感染药。我们发现在药房中替代药物的使用量显着增加（2006年：11.3％; 2007年：29.1％; 2008年：39.2％; p <0.0001）。结论：仅通过签订折扣合同，药房中出现了越来越多的替代药物。在此之前，自律监管没有太大的监管作用。
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