Doctors assume there will be an increasing need for counseling. /unai, stock.adobe.com
Berlin A regulation of the Federal Ministry of Health (BMG) stipulates that the remuneration of prophylaxis with nirsevimab against respiratory syncytial virus (RSV) should not be regulated in the evaluation committee. The National Association of Statutory Health Insurance Physicians (KBV) considers this to be legally questionable.
According to the regulation, the contractual medical services relating to the prescription and use of nirsevimab for infants, as well as counseling for guardians and the injection of the active ingredient, as well as prophylaxis indicated by the risk and basic fixed rates for general prophylaxis, must also be covered by the insured.
In this regard, there is no need to adjust the uniform valuation standard (EBM) for the invoicing of associated contractual medical services, it says literally in the draft regulation German medical journal is present.
The KBV has a completely different opinion. It shared its legal opinion today. According to the corporation, the legal ordinance can only regulate the right of those who have legal health insurance to the new benefit. The evaluation committee, however, should define the remuneration.
BMG now also shares this view, or so we were told, explained KBV boss Andreas Gassen. In this regard, it is more than annoying that the draft law still contains the statement that the benefit is included in the basic and insured flat rates and therefore no adjustment to the EBM is necessary.
This must be corrected in the legal regulation, Gassen warned. The basic and insured flat rates only included curative services and could not be charged for preventive services.
The Federal Ministry of Health has so far confirmed the statements of the KBV at the request of the German medical journal no.
Gassen also made it clear today that RSV prophylaxis requires a considerable amount of additional consultation work for practicing doctors. Especially with this new form of passive immunization, parents will have many questions about how it works and possible side effects. This high level of consultation effort should be adequately compensated with additional financial resources, added KBV Vice President Stephan Hofmeister.
RSV-specific prophylaxis with the monoclonal antibody Nirsevimab represents a very important measure to prevent deaths and an overload of children’s hospitals and pediatric practices due to respiratory infections with RS virus, said Sibylle Steiner, KBV board member.
For newborns and babies to feel Recommended by the Standing Vaccination Commission (STIKO). In order to be able to be immunized, if possible, before the start of the RSV season, legal regulations must be approved as quickly as possible and remuneration must be regulated.
With the regulation, the BMG wants to regulate the right of those with statutory health insurance to prophylactic administration of the monoclonal antibody drug Nirsevimab for all infants and newborns, based on the STIKO recommendation of June 27, 2024. The Federal Joint Committee (G-BA) cannot be transferred to standard care through the vaccination guidelines for statutory health insurance services. The reason is that it is not a normal vaccination.
The comprehensive claim is intended to prevent serious RSV-related illnesses, intensive care treatments, hospitalizations and deaths in newborns and infants of all gestational ages, regardless of possible risk factors, in the first RSV season in Germany and thus also to alleviate the burden on care capacities in the outpatient and inpatient areas of the Ministry.
According to the draft, by regulating the right to pre-exposure prophylaxis, the statutory health insurance (GKV) will incur additional annual expenses estimated in the three-digit millions. However, this does not take into account any fees that the evaluation committee would determine. © may/aerzteblatt.de