Direktabrechnung mit der PKV describes the arrangement in which a provider bills a private insurer directly for a service and the insured person never pays up front. The invoice goes to the insurer, the insurer settles it, and the customer signs a release so the provider may send the data. It is the opposite of the usual private arrangement, where the customer pays the provider and then decides for themselves whether to submit anything to their insurer.
The reason it exists is friction. A person who has to pay at the counter and then file paperwork feels the cost twice, and some will decline a service they would otherwise take. Where direct billing is in place, the service feels to the customer like the reimbursed side of the pharmacy, and the provider is paid without chasing a private debt. That convenience is also the catch. It only works where the insurer has agreed to it.
Direct billing is not a right and it is not a default. It rests on an agreement between the insurer and the provider, or on a scheme the insurer runs, and it covers only the services that agreement names. For pharmacy self pay services no such agreement is generally in place, so the realistic position is that the default remains Privatliquidation, a Rechnung an den Selbstzahler handed to the customer, paid by the customer, and submitted onward by the customer if they wish. Nothing about that submission is a promise of reimbursement, whichever route the invoice travels.
The comparison worth holding onto is with the physician side, where private billing runs on the GOÄ and insurers are accustomed to the codes it produces. A pharmacy does not invoice under that schedule, which is one practical reason a pharmacy invoice is harder for an insurer to process automatically. It is also worth noting how little of this resembles the reimbursed business, where the Packungsfixum rises from 8,35 to 9,00 euro on 1 July 2026 and to 9,50 euro on 1 January 2027, set by law and paid without any agreement being negotiated by the individual pharmacy.
If a pharmacy wants to pursue direct billing, the approach is to ask a specific insurer about a specific service and get the answer in writing, including what has to appear on the invoice and what consent has to be recorded. The tax treatment does not change with the payment route, it depends on the service, and it belongs with your Steuerberater before the first invoice.
This glossary entry is general information about German pharmacy law and practice. It is not legal advice. For binding guidance on your own pharmacy, contact your Landesapothekerkammer.
