title: [Expert evaluation of private drug prescriptions].
abstract: We propose a structured assessment of private prescriptions presented to the German Health Funds for reimbursement. A flow chart is presented. Given a medical indication, prescriptions in the context of clinical studies and possible legal exclusions should be identified. The expert opinion may be directed by Medicine Guidelines, regional contracts and court rulings. The individual case assessment should be combined with structural advice.
authors.affiliation: Medizinischer Dienst der Krankenversicherung (MDK), Hessen.
authors.forename: C
authors.initials: C
authors.lastname: Kreck
authors.forename: R
authors.initials: R
authors.lastname: Saller
mesh_terms: D011307:Drug Prescriptions; D005858:Germany; D006801:Humans; D007345:Insurance Claim Review / Q000331:legislation & jurisprudence*; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence*; D009313:National Health Programs / Q000331:legislation & jurisprudence*