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Abortion pill withdrawn in Germany after financial losses

BMJ 2000; 321 doi: (Published 28 October 2000) Cite this as: BMJ 2000;321:1041
  1. Annette Tuffs
  1. Heidelberg

    Distribution of the abortion pill, mifepristone (Mifegyne), in Germany is to be stopped by the end of 2000.

    The company that distributes the drug, Femagen in Bavaria, announced last week that it will stop distributing it to doctors and hospitals by the end of 2000 because of huge financial losses. Femagen orders the pill from the French producer Exelgyn.

    This year 96% of all abortions in Germany have still been carried out by surgery, and Femagen handled only 600 prescriptions a month instead of the expected minimum of 2000.

    This recent development adds another chapter to the difficult story of the introduction of mifepristone in Germany. After long discussions and strong opposition from the church and conservative politicians, mifepristone was finally introduced last year as an alternative to surgery.

    According to Petra Schoettler, managing director of Femagen, the main reason for the pill's failure is the low profit margin for pharmaceutical abortion compared with surgical abortion.

    Doctors are paid about DM500 (£148; $207) for a surgical abortion, but they receive just DM120 for prescribing mifepristone and the three necessary medical examinations of the patient, which, according to gynaecologists, does not cover their costs.

    In addition, most women seeking an abortion have a very low income. Costs of the abortion are usually not paid by health insurance, and, when a patient's income falls below a certain level, the costs must be covered by the federal states.

    Not all the states, however, cover the entire cost of mifepristone treatment. Women who do not receive social benefits are sometimes faced with a charge of DM800. Furthermore, the law permits direct distribution only to doctors and hospitals, which adds to the cost of mifepristone compared with drugs dispensed over the counter.

    Meanwhile, Exelgyn is looking for a new partner firm in Germany. Politicians, although enraged by this recent development, see no direct possibility of intervening as it is the responsibility of the doctors' associations and the health insurance companies to set rates of payment for standard treatments.

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