DiGA dispute: Two health insurance companies sign a cease-and-desist agreement - consequences for statutory health insurance companies

DiGA dispute: Two health insurance companies sign a cease-and-desist agreement - consequences for statutory health insurance companies

According to a report from www.fr.de, two statutory health insurance companies, IKK classic and Big Direkt, suffered legal consequences this year for their defensive behavior when dealing with DiGA prescriptions (digital health applications). The company DiGA aidhere, which had sued the health insurance companies, was able to win in court and obtain a cease-and-desist order that was punishable by law. This means that health insurance companies will now have to pay a penalty if they continue to redirect their insured persons to applications other than those prescribed by the doctor. Although this lawsuit was only filed against two health insurance companies, there are indications that other insurance companies may also attempt to hinder access to DiGAs, but through other methods such as requesting additional information in order to delay activation. DiGA aidhere has already filed a lawsuit against another health insurance company, which was settled out of court. It is unclear whether these violations are systematic or due to ignorance of the new law. It is suspected that the decentralized structure of some health insurance companies could lead to delays in implementing new procedures. It is emphasized that the majority of health insurance companies comply with the regulations.

These legal consequences for the two health insurance companies mentioned can have an impact on the market and the financial sector. On the one hand, this shows that the enforcement of patients' rights when using DiGAs is taken seriously and that this technology is recognized as an important part of healthcare. This could lead to more health insurance companies complying more closely with the regulations in the future and facilitating access to DiGAs, which in turn could lead to an increase in demand for these applications. This would allow companies that develop and offer DiGAs to benefit from a larger market.

On the other hand, the penalty could lead to financial burdens for the two health insurance companies. These penalties could have a negative impact on the health insurance companies' financial position and potentially affect their ability to offer other benefits to their members or to maintain stable contributions. It could also lead to reputational damage, as the affected health insurance companies could be viewed as unreliable and not patient-oriented.

Overall, it is positive that legal steps have been taken to ensure that patients have full access to DiGAs. However, it remains to be seen how the financial industry and the market will develop and whether other health insurance companies will adhere to the regulations. It is important that patients continue to know their rights and, if in doubt, can take legal action to ensure access to the digital health applications they need.