How Medication Reimbursement Works in PKV
Prescription medication is a core benefit of every comprehensive private health insurance (private Krankenversicherung, PKV) tariff. The key difference from statutory insurance (GKV) is the mechanism: rather than the pharmacy billing your insurer directly, privately insured patients usually pay the pharmacy and claim reimbursement from their insurer afterwards. You receive the medication, settle the bill, then submit the receipt and prescription for repayment.
What is covered: medically necessary, prescribed medication is generally reimbursed in full or up to your tariff terms. Lifestyle or non-prescription products are typically excluded, and your deductible (Selbstbeteiligung) may apply.
The E-Rezept for Private Patients
Germany has rolled out the electronic prescription (E-Rezept), and it now applies to privately insured patients too. Instead of a paper slip, your prescription is issued digitally. For PKV patients this works via the official E-Rezept app or a printed token, and the pharmacy dispenses against the digital prescription. You still typically pay and claim, but the prescription itself is electronic.
| Step | What happens |
|---|---|
| 1. Doctor prescribes | E-Rezept issued digitally (app or token) |
| 2. Pharmacy dispenses | Against the electronic prescription |
| 3. You pay | Settle the pharmacy bill |
| 4. You claim | Submit receipt and prescription record to your insurer |
What to Keep for Your Claim
Because you are reimbursed after the fact, documentation matters. Keep the pharmacy receipt (Quittung) showing the medication, price and that it was prescribed. With the E-Rezept, your insurer may accept a digital record; check whether your insurer has an app that lets you photograph and submit receipts directly, which speeds up repayment considerably.
Deductibles and Limits
Whether medication costs count toward your deductible depends on your tariff. In many tariffs, prescription costs are part of the outpatient benefits to which your Selbstbeteiligung applies, so in a low-claim year you might absorb medication costs within your excess. Preventive medication and certain treatments may be handled separately — check how your tariff treats pharmaceuticals when choosing a deductible.
Practical Tips
- Use your insurer's app if available, to submit receipts quickly
- Keep all prescription receipts until reimbursement is confirmed
- Ask about your deductible's treatment of medication so there are no surprises
- For regular medication, factor recurring costs into your deductible choice
The move to the E-Rezept makes prescriptions more convenient, but the PKV reimbursement principle — pay first, claim back — remains. Keeping clean records is the simplest way to ensure you are repaid promptly and in full.
Frequently Asked Questions
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