[Intravitreal injections of medications in Germany. Contract situation and legal conditions].

Despite the increasing application of both approved and off-label drugs for intravitreal administration, the German health system still does not provide an accounting code for the procedure of intravitreal injections. Health insurances and politicians are exerting pressure in order to limit the expected increase in the number of medications and costs due to demographic factors. Although the price for the drug can be determined by the manufacturer, a standing committee has to agree on the fee to be charged for the medical service of injection and subsequent examinations. Until the missing arrangement has been made, each individual surgeon can balance accounts with the patients who have claim for reimbursement. Many contracts have recently been made in order to regulate the extent of performance and charges for the application of medications and follow-up examinations to reduce administration costs. Due to medical liability and ethical code, physicians are obliged to provide a cost-effective and adequate treatment as well as a comprehensive preoperative patient education including efficacy, potential complications, limited prescription and free choice of a medical practitioner. It also appears prudent to explain relevant terms such as 'off-label' and 'level of evidence'. To prevent any suspicion of personal advantage, patients should be informed if placed contracts do not allow equal reimbursement for the same treatment or similar drugs.