What does “aut idem” mean?

“Aut idem” is Latin and means “or the same”. This means the exchange of a drug for another drug with the same active ingredient   . This exchange process is also called substitution. Legislation uses the term “aut idem” to describe the  replacement of an expensive drug by a lower-priced preparation with the same active ingredients  from the lower third of the price range. With “aut idem”, the doctor allows the pharmacist to dispense a drug that is cheaper than the one prescribed on a prescription, provided that it contains the same  active ingredient  .

Legal basis for “aut idem”

The AABG, i.e. the Drug Expenditure Limitation Act, came into force after its publication in the Federal Gazette on February 23, 2002. Since no third price limits could be set (calculation by the Federal Association of Company Health Insurance Funds) before the determination of therapeutically comparable dosage forms of the individual active ingredients (suggestions are made by the Federal Committee of Doctors and 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?

The substitution is planned:

  • when prescribing active ingredients. In these cases, the pharmacy must select a preparation from the lower third of the price range for sale (= inexpensive according to the law).
  • when prescribing a preparation that is not in the lower third of the price range (unless the doctor has ruled out substitution on the prescription sheet).

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

No substitution is planned:

  • if the doctor has already prescribed inexpensive.
  • if the doctor prohibits this by ticking a box on the prescription (or by making a corresponding note) – no matter how expensive the prescription is.

What does “aut idem” mean for patients?

The prescription is still made by the doctor. The pharmacist has to supply an inexpensive medicine. Unless the doctor prohibits the pharmacist from making a substitution on the prescription sheet by ticking the aut idem box. Only if  “aut idem” is not ticked  can the pharmacist dispense a cheaper drug.


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