First of all: The pharmacy has a general obligation to check whether the dispensing may take place on a GKV prescription. If the prescribed combination preparation has a certain standard size, then the ingredients must be checked. The content of preparations with a quantity between the standard sizes must also be checked:
- No refund: Medicinal products contain less than 300 mg of calcium ion per dosage unit of vitamin D, here the delivery is at the expense of the patient
Reimbursement can be made if the medicinal product contains at least 300 mg of calcium ion per dosage unit of vitamin D:
- If no diagnosis was noted on the prescription, the pharmacy has no further obligation to check and can bill the statutory health insurance.
Danger: If a diagnosis has been given, the pharmacy must check whether this corresponds to the criteria of the OTC overview (Annex 1 of the Medicines Directive):
- No refund: Criteria do not match – consult a doctor if necessary
- Refund: criteria match
Non-standard size pack
If the medication prescribed is not of a standard size, then the number of items is prescribed. If this is above the largest number (120 pieces), then the prescribed drug is one of the jumbo packs. It is therefore not possible to bill the pharmacy at the expense of the GKV – patients pay themselves.
OTC criteria for calcium and vitamin D combination products
- only at the same time as steroid therapy for diseases that are expected to require at least six months of steroid therapy with a dose of at least 7.5 mg prednisolone equivalent
- in the case of bisphosphonate treatment as specified in the respective product information if absolutely necessary
- Treatment of manifest osteoporosis