Changes in revenues associated with antimicrobial reimbursement reforms in Germany

Policy declarations from the G7 and other high-level meetings call for increased incentives for antimicrobial research and development (R&D). Governments fund push incentives like CARB-X and GARDP, and G7 countries are now designing pull incentives—financial rewards given to manufacturers post-market authorization that are intended to encourage the creation and introduction of novel antimicrobials. Germany has declared previously at the G7 that it has developed a pull incentive that will increase revenues from sales of important new antimicrobials, principally by exempting them from some aspects of health technology benefit assessments and reference pricing, which should result in higher prices. This policy move is the latest in a series of reforms that aim to improve the marketability of antimicrobials in Germany. This paper examines Germany’s reforms and contributes to the ongoing debate about the merits of its approach in light of R&D and access issues impacting the country, particularly in comparison to pull incentives such as revenue guarantees or subscriptions that delink revenue from sales volume. We find that in order for Germany to produce the same impact on antimicrobial revenues as a delinked pull incentive, it either needs to increase the volume of antimicrobials used or increase prices for these drugs by as much as 3.3-times current values.