What does “Aut Idem” Mean?

“Aut idem” is Latin and means “or the same.” This refers to the exchange of a drug for another drug with the same active ingredient. This exchange process is also called substitution. The legislation uses the term “aut idem” to describe the exchange of an expensive drug for a lower-priced drug with the same active ingredient from the lower price range. Thus, by “aut idem,” the physician allows the pharmacist to dispense a lower-priced drug than the one prescribed on a prescription, provided it contains the same active ingredient.

Legal basis for “aut idem”

The AABG, i.e., the Pharmaceutical Expenditure Limitation Act, came into force on February 23, 2002, following its publication in the Federal Gazette. Because no price-thirds limits could be set before therapeutically comparable dosage forms of the individual active ingredients (proposals are made by the Federal Committee of Physicians and Health Insurers) were determined (calculated by the Federal Association of Company Health Insurance Funds), the AABG could only be implemented gradually. Since July 1, 2002, the AABG has been applied to 170 aut idem groups.

When does aut-idem substitution occur and when does it not?

Substitution is provided for:

  • When active ingredient is prescribed. In these cases, the pharmacy must select a preparation from the lower price third for dispensing (= low-priced according to the law).
  • When prescribing a preparation that is not in the lower price third (unless the doctor has excluded the substitution on the prescription sheet).

If no price thirds were set for an aut-idem group under the AABG because fewer than five drugs were offered in the calculated lower price third at the time of calculation, one of the five lowest-priced products can generally be dispensed.

No substitution is provided:

  • If the doctor has already prescribed low-priced.
  • If the doctor prohibits this by ticking on the prescription (or by appropriate note) – no matter how expensive the prescription.

What does “aut idem” mean for patients?

The prescription is still made by the doctor. The pharmacist must dispense a low-cost drug. Unless the physician prohibits the pharmacist from substituting by checking the aut idem box on the prescription form. Thus, only if “aut idem” is not checked can the pharmacist dispense a lower-priced drug.