“The pharmaceutical industry has long been a guarantor of medical progress and prosperity in Germany. With around 130,000 jobs, billions in R&D investment, and an annual export volume exceeding 115 billion euros, it serves as a key engine for the economy and growth.
Securing the long-term financing of the statutory health insurance (SHI) system is a central priority. However, the measures currently proposed jeopardize patient access to innovative therapies and weaken the pharmaceutical industry. Raising and 'dynamizing' the manufacturer rebate, introducing 'focus lists,' and implementing de facto 'price caps' fail to recognize the value of innovation, make investment planning unpredictable, and undermine trust in the reliability of policymaking. This carries potentially serious consequences for patients, companies, and the economy as a whole.
It is worth remembering that the pharmaceutical industry makes a substantial contribution to SHI savings every year through mandatory rebates—amounting to around 29 billion euros in 2025 alone. There are already more than 30 different price regulation mechanisms in place, including an existing manufacturer rebate. Further rebates would have significant consequences—and cause more economic harm than good. A study by the *Pharmainitiative Bayern* shows that raising the manufacturer rebate by nine percentage points would result in a cumulative nominal loss of 48 billion euros in value creation and the loss of 21,000 jobs by 2030.
The consequences for patient care are also alarming. Plans are underway to extend rebate contracts to patent-protected medicines—a mechanism previously applied only to generic drugs. This would dilute the assessment of medicines based on medical benefit and encourage a system of care driven by 'fund availability' rather than clinical need. It would restrict physicians' freedom of treatment and further complicate patient care.
Even now, German patients face difficulties due to lengthy access to innovative therapies is significantly less common due to EU approval processes. In Germany, one in three drugs newly approved in the US is now unavailable.
While the US government actively fosters pharmaceutical innovation through rapid approval processes and investment incentives, it simultaneously exerts trade-related pressure on Europe: the "Most-Favored-Nation" rule introduced by the US ties drug prices in the US to the lowest prices found in G7 countries. The looming consequence is that some manufacturers may choose not to launch certain drugs in Germany at all, or to delay their introduction.
One thing is clear: the European pharmaceutical industry is increasingly losing competitiveness and health sovereignty, particularly vis-à-vis the US and China.
Around 25 years ago, Europe was responsible for developing nearly one in every two new drugs worldwide; today, that share stands at just 20 percent. At the same time, the share of clinical trials dropped from 22 percent to 12 percent. This means that 60,000 patients in Europe have had less access to clinical trials—and, by extension, to innovative therapies.
Instead of reversing this trend in Europe, Germany risks widening this gap further with its planned reform of statutory health insurance (SHI) financing.
The coalition agreement set the goal of making Germany a leading international hub for the pharmaceutical and biotechnology sectors and creating a predictable framework for the industry. The legislation currently being planned moves in completely the wrong direction in this regard: it creates immense uncertainty, imposes significant additional burdens on the industry, undermines our competitiveness and health sovereignty, and disincentivizes investment in innovation.
The right approach, however, would be to first tackle long-overdue structural tasks—such as fully removing costs unrelated to insurance coverage from the system or streamlining the self-governance of statutory health insurance.
Furthermore, it is essential to make the German healthcare system fit for the future and to think bigger: bureaucratic hurdles must be dismantled, processes accelerated, and innovation targetedly fostered.
Furthermore, we need to build a robust innovation ecosystem to support research and clinical trials.
I am convinced that pharmaceutical innovation is not merely a "cost factor." Rather, we must view innovation as an investment in the future. Earlier screening options that enable faster treatment can help avoid significant costs—such as those arising from subsequent hospital stays. In this regard, Japan offers excellent examples in the prevention of chronic kidney disease: Universal urine tests for proteinuria during routine health checkups help find silent kidney issues early. According to a recent Prognos study, the consistent application of innovations from the industrial sector of the healthcare industry could save more than 20 billion euros annually within the statutory health insurance system.
The question of how to appropriately reward innovation also belongs on the agenda. We need pricing for pharmaceuticals that is clearly based on value, and we must enable inflation adjustments for approved products. From an industrial policy perspective, what is needed is active support for innovation and resilience—rather than completely impractical exemption rules regarding increased manufacturer rebates for companies operating in Germany. We should also seize the opportunities offered by a health insurance system with a stronger capital-funded component.
A constructive discussion on the future design of the German healthcare system must address the value we place on our health, how to improve patient care, and how to position the healthcare industry for sustainable success. To achieve this, we need policies that offer reliability and foster innovation instead of stifling it.
Shashank Deshpande is Chairman of the Board of Managing Directors at Boehringer Ingelheim.
“The statutory health insurance reform approved by the Cabinet deprives the German pharmaceutical industry of the basis for future planning.” [1]
1. Warum wir bei Pharmainnovation gerade den Anschluss verlieren. Frankfurter Allgemeine Zeitung; Frankfurt. 02 May 2026: 20. Von Shashank Deshpande
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