exclusive
Three months ago, a Saxon pharmacist made it public how profitable the preparation of cancer infusions is. Since then, according to information from NDR, WDR and SZ are under pressure in the industry.
Robert Herold had broken the silence. In July of this year, he made public how cheaply cancer pharmacists like himself can buy many medications for infusions – and how much more expensive they charge them to health insurance companies.
For some active ingredients, cancer pharmacists can earn up to 1,000 euros from a single infusion bag – in addition to the flat-rate production fee that they receive anyway and which is supposed to cover costs and profits. If the health insurance companies only reimbursed the actual, low purchase prices, those with statutory health insurance could, according to calculations NDR, WDR and “Süddeutscher Zeitung” (SZ) save up to 500 million euros every year.
Lauterbach promised a remedy
The astonishment was great when this media and that ARD-Magazine monitor reported comprehensively and in detail for the first time in July about the enormous profit margins of cancer pharmacists. Federal Health Minister Karl Lauterbach said at the time: This was “definitely something that we also have to address in terms of regulation.” The high profits are “not a sustainable situation”.
But little has happened since then. Last week, CSU member of the Bundestag and health politician Stephan Pilsinger asked the government what specific measures had been taken so far. The short answer from the parliamentary state secretary from Lauterbach’s ministry was: The ministry had scheduled “a technical discussion with the specialist circles” for November with the aim of an “in-depth investigation of the facts”. Only then can possible changes to the law be examined.
Pilsinger criticizes the inaction. “The findings from the summer have made it more than clear that the production of cytostatics in pharmacies requires fundamental regulation,” said the CSU health politician. “Nothing has happened here since July.”
Print of Pharmacist organizations
The pharmacists’ guild itself, however, reacted quickly – and put their colleague Robert Herold under pressure. Herold is part of a purchasing group called Auriga together with the President of the Association of Cytostatic Pharmacists (VZA), Klaus Petersein.
According to information from NDR, WDR and SZ accuse Petersein and his pharmacist colleagues of Herold of behavior that is damaging to the business. The pharmacists deny that their profits are too high and point, among other things, to the high costs for their laboratories, which are allegedly not profitable with the flat-rate production fee that the health insurance companies also pay.
Herold, the health insurance companies and a report commissioned by the government see it differently. Nevertheless, Herold should now be excluded because the purchasing group should serve to promote the economic and social interests of its members. He damaged these interests.
VZA President Petersein also sharply criticized Herold at the Auriga Pharmacist shareholders’ meeting. The meeting finally decided, “unanimously,” as the minutes stated, to exclude Herold from the purchasing group.
Herold rejects allegations
When asked, Herold himself said that he had been accused of his behavior being unspeakable: “I would have damaged all pharmacists and the citizens’ trust in oncological production. I cannot understand that.” President Klaus Petersein, who himself runs the cathedral pharmacy in Essen, responded to a request from NDR, WDR and SZ doesn’t respond.
Herold himself says that he has “received positive feedback from many patients,” including some from doctors. The headwind only came from pharmacists who prepare cancer drugs.
Pharmacist loses Speaker position
But the fact that his colleagues excluded Herold from the Auriga purchasing group is not the only consequence for the whistleblower. The Saxon State Chamber of Pharmacists, for whom Herold had previously worked as a training officer, also excluded him from this activity. A letter from the State Chamber of Pharmacists to him stated that they wanted to “avoid unnecessary discussions” during the training courses.
What exactly is Robert Herold’s business-damaging behavior? And what protection do whistleblowers enjoy at the chamber when they draw attention to abuses within their profession? The President of the Saxon Chamber of Pharmacists, Göran Donner, explained at the request of NDR, WDR and SZ, that Robert Herold was temporarily excluded from the training courses “solely for his own protection”. “In addition, it remains up to the chamber to decide who, when and where appears as a speaker for the chamber,” said President Donner.
Piechotta sees the procedure as an example of “bad error culture in the healthcare system”.
Health politician defends Herald
After the publication of the allegations, the Green Party member of the Bundestag and budget politician Paula Piechotta made contact with pharmacist Herold and visited him in Saxony. “This is a rock-solid pharmacist with a great sense of justice who doesn’t want money taken out of patients’ pockets,” says Piechotta.
“The way he is now being dealt with is highly problematic and unfortunately an example of a bad error culture in the healthcare system,” said the MP. The health system must reward pharmacists like Herold if they are particularly honest and conscientious and inform the public. Instead, it apparently punishes these people.
Health insurance companies propose new model
The health insurance companies are now pinning their hopes on the conversation in the Lauterbach Ministry, which is planned for the end of November. The AOK Federal Association wants to ensure that health insurance companies are allowed to advertise for their members at regional level. Cyto-pharmacists should be able to apply to provide care in small areas with a maximum travel distance of 30 minutes.
The cheapest pharmacy then gets the surcharge for everyone with statutory health insurance in the region, says AOK pharmaceutical expert Sabine Richard, explaining the model in an interview with ARD magazine Monitor. This would relieve the burden on contributors. “A few years ago we identified a savings potential of around 600 million euros per year for the entire statutory health insurance,” says Richard. “And we assume that we will come back to this size again.”
Whether this can ultimately be achieved now depends on Health Minister Lauterbach. This would have to allow health insurance companies to advertise in this area, which was only banned in 2017 with the help of the pharmacy lobby. Health Minister at the time was Hermann Gröhe (CDU).
Herold does not regret his actions despite the consequences for him.
“I would do it again”
Robert Herold has thought a lot about whether he would make the true purchase prices of cancer drugs public again today. But he is sure: “I would do it again.” Herold says he is convinced that cancer patients in their exceptional situation need local care, that is, a pharmacist who can also take care of side effects and interactions.
However, he also sees that reporting alone does not solve problems. “I think that’s the biggest danger: you do a report and then it all fades away.”