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SummaryOn Friday, 10 July 2026, the Bundestag adopted the GKV-Beitragssatzstabilisierungsgesetz (BStabG) in a recorded vote: 319 in favour, 286 against, 4 abstentions.1 That same afternoon the Bundesrat, in its last session before the parliamentary summer recess, let the act pass and declined to call the Mediation Committee.3 The BStabG is thus adopted; signing by the Federal President and promulgation in the Federal Law Gazette (BGBl.) follow shortly. This article continues our BStabG series and covers the final vote and the concrete consequences for action. It is written for professionals, not patients.
The legislative procedure stayed politically charged to the end. On 8 July the Green and Left parliamentary groups moved to take the vote off the agenda, without success, and two urgent applications to the Federal Constitutional Court also failed.4 In the procedural debate the coalition was accused of tabling around 300 pages of amendments at short notice.4
On balance the parliamentary procedure burdened the research-based pharmaceutical industry more than the original government bill. The association of research-based pharmaceutical companies (vfa) notes that while hospitals, the insured and in part the medical profession were relieved, the burdens on the pharmaceutical industry were significantly tightened again in several places.7
The most important change: the dynamic manufacturer discount was dropped. In its place comes a fixed additional discount of 8.5 percent. Together with the existing 7 percent discount, that yields a total discount of 15.5 percent from 1 January 2027, plannable, but higher than proposed in the government bill.
| Instrument | Government bill (29 April 2026) | Parliamentary version (10 July 2026) |
|---|---|---|
| Manufacturer discount for patent-protected medicines (section 130a(1b) SGB V) | Existing 7% discount stays. Addition: dynamic surcharge, entry +3.5% from 1 Jan 2027 (= 10.5% total), then annually variable from 1 Jul 2027 by GKV expenditure and revenue. Height not calculable in advance. | Existing 7% discount stays. Dynamic element dropped. Addition: fixed surcharge +8.5% from 1 Jan 2027 (= 15.5% total). Static, plannable. |
| Exemption: active-ingredient production in Germany | Foreseen: companies with active-ingredient production in Germany to be partly relieved from higher discounts. | Dropped. Instead: a coalition resolution (Drucksache 21/7063) is to create a location clause as a separate follow-up act by 1 Jan 2027. |
| Price-volume rule | Rebate factor 1% per exceeded 100-million-euro revenue tier. | Rebate factor raised to 1.5% per revenue tier (+50%). Mainly hits high-revenue patent substances. |
| Vaccine discount (section 130a(2) SGB V) | New: additional 7% discount for patent-protected vaccines without a reference discount, from 1 Jan 2027. | Discount raised to 9%. Addition: price moratorium for patent-protected vaccines until 31 Dec 2030 (reference date 1 Jun 2026). |
| Rebate contracts for patent-protected medicines (section 130e SGB V, recast) | Funds may, for the first time, tender therapeutically comparable patent-protected medicines within 5 pilot groups: PD-1/PD-L1, PCSK9, PARP, JAK, CGRP. Group formation with the funds. | Adopted unchanged. |
| General price moratorium (section 130a(3a) SGB V) | New reference from 1 Jan 2027: the lowest market price of any supplier of the same active ingredient, no longer the manufacturer's own price of 1 August 2009. Extended to 31 Dec 2030. | Adopted as in the government bill: lowest market price of any supplier as reference, for all GKV-reimbursable medicines (reference-price products exempt). Until 31 Dec 2030. |
All figures based on the bill BT-Drucks. 21/61306 and the committee report 21/7023,6 and on vfa calculations for the parliamentary version.7
Alongside adopting the BStabG, the coalition groups CDU/CSU and SPD passed a resolution (Drucksache 21/7063) calling on the federal government to develop a location clause, within the pharma and medical-technology dialogue, by the end of September 2026 at the latest. The stated aim is a substantial reduction of the statutory manufacturer rebate9 for companies that research and produce in Germany. The clause is to apply where a company demonstrates:9
The intended timetable: a bill in cabinet by the end of October, second and third reading before Christmas 2026, entry into force on 1 January 2027.9 The size of the reduction is not yet fixed in the resolution. The federal government also gave a declaration to the record in the Bundesrat: an interministerial expert body is to develop legally robust proposals by the end of September 2026, including instruments outside the statutory health insurance such as EU funding and location support from the Federal Ministry for Economic Affairs.3
Pharmaceutical industry: vfa president Han Steutel stated that the Bundestag had adopted an act that endangers the supply of patients with innovative therapies in Germany.7 By vfa calculations, the financial burden on the research-based industry in 2027 rises, through the sum of the parliamentary changes (higher manufacturer discount, tightened price-volume rule and higher vaccine discount), from an originally expected 1.1 billion to around 3.2 billion euro.7 Some companies had already questioned planned investments in Germany.11
GKV umbrella association: its chair Oliver Blatt called the outcome a lenient programme for the industry, noting that at 15.5% the discount is below the 17% seen in the past, and that savings potential was given away.5
Bundesrat: six federal states (Saarland, Bremen, Hamburg, Mecklenburg-Vorpommern, Lower Saxony and Saxony-Anhalt) had prepared a joint motion to call the Mediation Committee, but no majority formed.3
| Instrument | What finally applies | From when |
|---|---|---|
| Manufacturer discount for patent-protected medicines | 15.5% total (7% existing + 8.5% fixed new). Applies to patent-protected medicines without a reference price. No automatic mechanism. Possible reduction via the location clause. | 1 Jan 2027 |
| Rebate contracts for patent-protected medicines (section 130e SGB V) | Funds may tender therapeutically comparable patent-protected medicines within the 5 pilot groups (PD-1/PD-L1, PCSK9, PARP, JAK, CGRP). Group formation with the funds, not the G-BA. Pilot phase until 31 Dec 2030. | On entry into force (summer 2026) |
| Price moratorium + vaccine discount | New price reference from 1 Jan 2027: lowest market price of any supplier of the same active ingredient (previously the manufacturer's own price of 1 August 2009). Applies to all GKV-reimbursable medicines; reference-price products exempt. Until 31 Dec 2030. Vaccine discount 9% plus its own price moratorium until 31 Dec 2030 (reference 1 Jun 2026). | 1 Jan 2027 |
| Price-volume rule (tightened) | 1.5% rebate factor per exceeded 100-million-euro revenue tier (previously 1%). | 1 Jan 2027 |
| Date | What enters into force |
|---|---|
| Summer 2026 (after BGBl. promulgation) | Section 130e in force. Funds can prepare tenders for the 5 pilot groups. |
| End of September 2026 | Location-clause concept by the interministerial expert body (per resolution 21/7063 and the government's declaration to the record). |
| End of October 2026 | Cabinet decision on the location-clause act (targeted). |
| 1 Jan 2027 | Total manufacturer discount 15.5% + price-volume rule 1.5% + new price moratorium (reference: lowest market price of any supplier) + vaccine discount 9%. Possibly simultaneously: the location clause. |
| 31 Dec 2030 | End of the section 130e pilot phase. Evaluation. Possible extension to further substance groups. |
Manufacturers and market-access teams should run an exposure analysis (which products fall under the 15.5% total burden, which under exemptions such as reference price, biosimilar, supply-critical or clinical trials in Germany) and prepare IFA notifications accordingly. Companies that recruit at least 5% of their worldwide trial participants in Germany and can demonstrate local R&D or production should document their location-clause qualification now, since the timetable is tight. They should check whether their own products sit in the PD-1/PD-L1, PCSK9, PARP, JAK or CGRP pilot groups, and note that under the new moratorium the first market entrant after patent expiry sets the price reference for all followers, making the launch date an economic lever. The underlying pricing data is set out in our overview of pharmaceutical pricing and market access in Germany.
Pharmaceutical wholesale faces a concentration risk: section 130e concentrates demand on the tender winner, so non-winners lose volume across all five pilot groups. Tender winners must suddenly cover the demand of large fund collectives, a shortage risk that rewards identifying capacity and alternative sources early, while stock at old purchase prices can lose value as tender terms and the 15.5% discount interact. A real-time view of reported shortages, such as a drug shortage database for Germany, supports early warning.
Pharmacies may face exclusive award contracts for patent-protected medicines under section 130e in addition to existing generic rebate contracts, so a current rebate-contract overview and shortage information are the mandatory basis for correct dispensing and billing.
Health insurance funds hold section 130e in force on promulgation, with group formation, equivalence assessment and tender design for the five pilot groups resting entirely with them, drawing on G-BA benefit assessments as the basis for the tender design.
The dynamic manufacturer discount is history. Plannability was the decisive compromise, bought with a fixed total discount of 15.5%, a tightened price-volume rule and a higher vaccine discount. The burden on the research-based industry has nearly tripled against earlier expectations. The location clause is the one remaining variable that could change the picture again, and for companies with a strong presence in Germany the qualification check is now, not in the autumn. pharmazie.com keeps professionals current with IFA data, price history, an AMNOG database and a shortage overview in one platform, exclusively for healthcare professionals.
1 Deutscher Bundestag: recorded vote on the GKV-Beitragssatzstabilisierungsgesetz, 10 July 2026. bundestag.de
3 Deutsches Ärzteblatt: GKV reform passes the Bundesrat, 10 July 2026. aerzteblatt.de
4 Deutscher Bundestag: after a heated debate, the Bundestag adopts the GKV finance reform (session report KW28). bundestag.de
5 Pharmazeutische Zeitung: GKV savings act passes the Bundesrat, 10 July 2026. pharmazeutische-zeitung.de
6 Bundesregierung: BT-Drucksache 21/6130 (bill, 29 April 2026) and 21/7023 (committee report, 8 July 2026). dserver.bundestag.de
7 vfa: the pharmaceutical industry bears higher burdens, press release and fact sheet on the parliamentary version, 10 July 2026. vfa.de
9 Deutsches Ärzteblatt: coalition groups want to accommodate the pharmaceutical industry with a location clause, 6 July 2026. (Bundestag Drucksache 21/7063.)
