PKV medication coverage means that private health insurance reimburses prescription medicines, as far as your tariff includes them and they are medically necessary. You pay at the pharmacy, submit the prescription and receipt to your insurer and receive the amount according to your tariff. How much you bear yourself is determined by your deductible, your reimbursement rate and maximum amounts in your tariff. The statutory co-payment of the health funds is a GKV rule. Our overview of what PKV covers (in German) shows the tariff benefits.
PKV medication coverage at a glance
- Privately insured people pay at the pharmacy themselves and submit the prescription and receipt to their insurer.
- Reimbursement depends on the tariff: Reimbursement rate, deductible and maximum amounts decide.
- Not every tariff reimburses over-the-counter drugs. Ask your insurer before you buy.
- Statutory insured people pay 10 per cent for medicines, at least 5 euros and at most 10 euros. According to the Federal Ministry of Health, co-payments are planned to rise by 50 per cent, which would mean at least 7.50 and at most 15 euros.
How does reimbursement of medication work in PKV?
You redeem the prescription at the pharmacy and pay the price yourself. Afterwards you submit the prescription and purchase receipt to your insurer, by post or digitally. The insurer reimburses according to your tariff. There is no direct contractual relationship between pharmacy and insurer, which is how cost reimbursement works in PKV in general.
You have three years to submit claims, counted from the end of the year in which the invoice was issued. A receipt from March 2026 can therefore be submitted until 31 December 2029. The principle behind this is explained in our article on cost reimbursement in PKV (in German).
Does PKV pay for prescription medicines?
As a rule, yes, provided your tariff includes medicines and the medicine is medically necessary. How high the reimbursement is depends on your reimbursement rate. If your tariff has a deductible, you bear costs up to that amount yourself. More on the variants is in our article on deductibles in PKV (in German).
Are over-the-counter medicines reimbursed?
Whether over-the-counter drugs are reimbursed is set by your tariff. Some tariffs require a medical prescription for this. So before you buy, ask your insurer whether and under which conditions it pays, and keep the answer. For homeopathic and herbal remedies, the rules of your tariff apply; see our article on natural remedies in PKV (in German).
What about fixed amounts and maximum limits?
A fixed amount is a price ceiling for a medicine. Whether and how such limits affect your reimbursement is stated in the tariff conditions. Check there too whether there is an annual maximum and whether it applies to medicines. If you regularly need medicines, clarify this before you take out a tariff.
What do statutory insured people pay?
| Co-payment | GKV 2026 | GKV after the planned 50 per cent increase (entry into force open) |
|---|---|---|
| Medicines | 10 per cent, at least 5 euros, at most 10 euros, never more than the cost | Calculated at least 7.50 euros, at most 15 euros |
| Hospital | 10 euros per calendar day, for at most 28 days | Calculated 15 euros per day |
The 50 per cent increase is part of the GKV Contribution Rate Stabilisation Act (GKV-Beitragssatzstabilisierungsgesetz). The Federal Ministry of Health does not state a date for the entry into force on its page of 10 July 2026. The statutory cap limits co-payments in GKV: Statutory insured people must pay at most 2 per cent of their annual gross income for their living costs, and 1 per cent for those with chronic conditions. The Verbraucherzentrale explains how exemption from co-payments works.
Which services belong to vaccinations and preventive care?
Vaccines are also medicines, but they follow their own rules. In GKV, recommended vaccinations are a mandatory benefit. In PKV, your tariff determines what is reimbursed. You will find more in our article on PKV and vaccinations (in German). For examinations and early detection, look at PKV preventive services (in German).
What risks come with PKV during your studies?
The exemption from statutory insurance cannot be revoked and normally applies to the whole course of study. A switch back to GKV is normally only possible after your studies. Contributions may rise.
Frequently asked questions
Does PKV reimburse medicines without a prescription?
Your tariff decides. Some tariffs require a medical prescription, others exclude certain products. Ask your insurer before you buy whether it covers the cost, and keep the answer.
Do privately insured people pay a co-payment for medicines?
The statutory co-payment is a GKV rule: There, insured people pay 10 per cent, at least 5 euros and at most 10 euros. In PKV, the deductible and reimbursement rate of your tariff determine what share you bear.
How do I submit a prescription to PKV?
You send a copy of the prescription and the pharmacy receipt to your insurer, by post or digitally. Which documents exactly are needed is set out in your insurer’s instructions.
What is a fixed amount in PKV?
A fixed amount is a price ceiling for a medicine. Whether your tariff provides maximum limits and what applies beyond them is stated in the tariff conditions. If in doubt, ask your insurer before you buy.
So what should you do now
- Read in your tariff conditions what they say about medicines.
- Note your reimbursement rate, deductible and any maximum amounts.
- Ask your insurer before buying over-the-counter medicines.
- Submit prescriptions and receipts promptly and keep copies.
If you want to talk through your situation, you will find the way to advice on the Academycon homepage.
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Related reading
- Single or shared room in PKV: What suits you? (in German)
- Choosing a PKV deductible: How high should it be? (in German)
- Natural remedies in PKV: What is reimbursed (in German)
Last updated: October 2026. This article provides general information and does not replace individual advice.
