AMNOG generally only refers to outpatient drug prices regulated by the Drug Price Ordinance. In the inpatient area, drug prices are agreed directly between the pharmaceutical contractor and the hospitals. In this respect, the AMNOG reimbursement amount only has a signal effect for negotiations in the stationary sector. The reimbursement in the inpatient area between the hospitals and the health insurance companies is based on the inpatient reimbursement system. For the reimbursement of new drugs, hospitals can submit a so-called NUB application to the Institute for the Hospital Remuneration System (InEK). If the InEK determines that the new drug is not yet properly remunerated with the DRG system, a NUB fee for the innovative drug can be agreed between the requesting hospital and the health insurance companies.
This means that the new service is reimbursed in addition to the lump compensation for the DRG system. NUB applications can only be submitted once a year with a deadline of 31 October; the decision of the InEK is taken by the end of January of the following year. Medicines that are used exclusively in the inpatient area can be exempted from the early benefit assessment according to AMNOG. An exemption application must be submitted to the Federal Joint Committee at least 3 months before it is placed on the market.