'Prescriptions for Medications in Germany: E-Rezept, Types, Validity

In Germany, many medications are available only with a doctor’s prescription. This applies to antibiotics, strong painkillers, certain hormonal medications, and other drugs where self-medication can be dangerous. For patients, the most important thing is to understand three things: whether a prescription is required, who pays for the medication, and how long they have to pick it up at the pharmacy.

Starting in 2024, the standard prescription for patients with public health insurance will most often be issued as an E-Rezept. Paper forms are still used in certain cases, and special forms are used for certain categories of medications, such as Betäubungsmittel.

Which Medications Are Available Over the Counter and Which Require a Prescription

German medications are broadly divided into several groups:

• Over-the-counter products: vitamins, basic personal care products, and some eye drops and dietary supplements can be found not only in pharmacies;
• over-the-counter medications: OTC drugs that are sold without a prescription, but usually only at a pharmacy;
• prescription medications: antibiotics and many medications for chronic conditions, which are available only with a prescription;
• Strictly controlled medications: Betäubungsmittel and certain potent drugs that require a special prescription.

If you’re unsure whether a prescription is required, it’s best to ask your doctor or pharmacist. A pharmacy is not permitted to dispense a prescription medication simply because the patient has purchased it before in another country.

How to Get a Prescription

A prescription is usually written by a doctor after a consultation: a general practitioner, a specialist, or a hospital physician. For repeat prescriptions for chronic conditions, a practice can often issue a prescription without a new full consultation if the patient is already under that doctor’s care. The conditions depend on the practice, insurance, and medical situation.

If you’re seeing a doctor in Germany for the first time, start by making an appointment: contact a doctor. It’s important for patients with public health insurance to regularly verify their insurance status using their electronic Gesundheitskarte, especially when seeking care in a new quarter.

Foreign prescriptions may sometimes be accepted, but this is not a universal rule. The pharmacy checks whether the document meets German requirements and whether the prescribing physician, patient, medication, dosage, and date of prescription can be identified. For controlled substances, you should not count on being able to fill a prescription based on a foreign prescription.

E-Rezept: How Electronic Prescriptions Work

For prescription medications in the public health insurance system, the E-Rezept has become the standard. The doctor creates an electronic prescription, signs it with an electronic signature, and the patient gains access to it in one of the following ways:

• via the electronic health card at the pharmacy;
• in the E-Rezept app;
• via a paper printout with a code;
• In some cases, through the pharmacy’s app using CardLink.

For most patients, the easiest option is to show their electronic health insurance card at the pharmacy. The prescription itself is not stored on the card; rather, the card helps the pharmacy locate the electronic prescription within a secure system.

The E-Rezept is particularly convenient for refills: if the doctor has already seen the patient and their insurance status has been confirmed, there’s sometimes no need to visit the doctor’s office just to get a paper prescription. However, technical glitches, delays in signing, or the need for an in-person examination are still possible, so it’s best not to wait until the last minute to pick up urgent medications.

Types of Prescriptions in Germany

Historically, prescriptions were often distinguished by color. Following the transition to the E-Rezept, the color of the paper form is no longer always visible to the patient, but the logic behind payment and time limits remains the same.

Pink Prescription and E-Rezept for GKV

The pink health insurance prescription (Kassenrezept) is intended for patients with public health insurance if the medication is covered by the GKV. In electronic form, this is usually an E-Rezept.

A patient at a German pharmacy pays not the full price, but the gesetzliche Zuzahlung (statutory copayment), unless exempt from the copayment. In 2026, the basic rule for adults in the GKV is: 10% of the medication’s price, with a minimum of 5 euros and a maximum of 10 euros, but no more than the actual cost of the medication.

Examples:

• The medication costs 150 euros: 10% of that is 15 euros, but the patient pays a maximum of 10 euros;
• The medication costs 12.50 euros: 10% of that is 1.25 euros, but due to the minimum copay threshold, you usually pay 5 euros;
• The medication costs 4 euros: the patient does not pay 5 euros, because the copayment cannot exceed the price of the medication.

Children and adolescents under 18 are generally exempt from this copayment. Adult patients may also be exempt from the Zuzahlung once they reach the established cost-sharing limit, but this must be arranged through their Krankenkasse.

Sometimes an additional cost difference arises due to the Festbetrag: the health insurance provider covers the medication only up to a set maximum for that drug group, and a more expensive option may require a copayment in addition to the usual Zuzahlung. In such a situation, it’s worth asking your doctor or pharmacist if there is an equivalent medication available without this additional cost difference.

What Do the Fields on the Pink Prescription Mean?

It’s still helpful to know how to read a paper pink prescription: it explains how the pharmacy calculates the cost and exactly what the doctor has prescribed.

Fields on a German prescription, using a pink form as an example

1. On the left-hand side are the prescription status indicators. They show whether there is an exemption from copayments, whether the prescription is related to an accident or a work-related injury, and other billing details.
2. Name of the public health insurance provider.
3. The patient’s name, address, and date of birth.
4. Insurance status information.
5. Insured person’s number.
6. Patient status code.
7. The doctor’s or practice’s number.
8. Health insurance card information.
9. Date the prescription was issued.
10. aut idem fields: If a doctor prohibits substitution, the pharmacy must not dispense a generic equivalent in place of the specified medication.
11. Medication names. A single prescription may list multiple items.
12. The doctor’s information and signature. For a paper prescription, the signature is essential.
13. Additional notes for special cases: medical aids, vaccines, specialized counseling, and other indicators.
14. Information about the pharmacy that dispensed the medication.
15. The price or amount the patient pays, as charged by the pharmacy.

Green Prescription

A green prescription is a doctor’s recommendation for an over-the-counter medication. Usually, the patient pays for the medication themselves, regardless of whether they are insured under GKV or PKV.

Green German prescription – the medication is not covered by health insurance

The green prescription is often used for over-the-counter (OTC) medications: herbal remedies, certain pain relievers, cold remedies, or supportive therapies. It’s a good idea to keep it along with your receipt: some health insurance providers partially reimburse these expenses according to their own rules, and in some cases, the costs can be claimed on your tax return as medical expenses. Reimbursement is not guaranteed, so you should check the terms and conditions with your health insurance provider or tax advisor.

Blue Prescription

The blue prescription is most commonly associated with private health insurance (PKV). The patient pays the full cost of the medication at the pharmacy and then submits the prescription and receipt to their PKV provider for reimbursement according to their plan’s terms.

Important: A private prescription does not have to be blue. A doctor may issue a Privatrezept on a different form as long as the document contains the necessary information, a signature, and a stamp. For GKV patients, a blue or private prescription is also possible if the medication is not covered by the public health insurance fund.

Yellow Prescription: Narcotics

The yellow BtM prescription is used for medications that fall under the Narcotics Act (Betäubungsmittelgesetz): for example, certain strong painkillers and highly controlled substances. Such prescriptions are documented with particular rigor.

A BtM prescription usually consists of three parts:

• One copy remains with the doctor;
• one is kept by the pharmacy;
• One is used for reporting and reimbursement.

For Betäubungsmittel, a special paper prescription will still be required in 2026; the standard E-Rezept does not apply to these medications. Purchasing medications that require a BtM prescription through dubious online sources is dangerous: a legitimate pharmacy must comply with German dispensing and documentation regulations.

Prescription Validity Periods

The timeframe depends on the type of prescription and whether the medication is covered by health insurance or must be purchased out-of-pocket.

Medical prescriptions come in different colors in Germany

Prescription Type	Typically for	Who Pays	Estimated Validity Period
E-Rezept / pink health insurance prescription	GKV patients	GKV plus patient copay	Valid for reimbursement by the health insurance provider for 28 days from the date of issuance; the technical validity of the E-Rezept may be longer
Green Prescription	OTC Medication Recommendation	Typically for the patient	Usually valid indefinitely, but reimbursement by the health insurance provider or tax treatment depends on the regulations
Blue Privatrezept	Private insurance or out-of-pocket	Patient pays first, then possible reimbursement from PKV	Usually 3 months
Yellow BtM Prescription	Controlled Substances	GKV/PKV depending on insurance coverage	Very short validity period: must usually be presented at the pharmacy within 8 days, including the day of issuance

Don’t put off picking up your medication, especially if it needs to be ordered. If the deadline has passed, the pharmacy may refuse to dispense it or suggest that you get a new prescription.

Copayments and Ways to Reduce Costs

If a medication turns out to be expensive, you don’t have to silently accept the first price quoted. You can:

• Ask the pharmacist if the medication is available without a copayment beyond the Festbetrag;
• Ask your doctor if the medication can be substituted with a generic version containing the same active ingredient;
• Check whether your health insurance provider has agreements or rules regarding exemption from copayments;
• For recurring expenses, apply for an exemption from copayments (Zuzahlungsbefreiung) once the copayment limit has been reached;
• Compare prices for over-the-counter medications, which the patient pays for out of pocket.

Night or on-call pharmacies may charge a Notdienstgebühr. If you need the medication urgently, this is a normal part of emergency service; if your purchase isn’t urgent, it’s cheaper to go during regular hours.

What to Check Before Going to the Pharmacy

• Who the prescription is written for and whether the patient’s information matches.
• Does the prescription include a clear name of the medication, the dosage, and the dosage form?
• Has the prescription expired?
• Is substitution via the “aut idem” notation prohibited?
• Do you need to order a rare medication in advance?
• Is there an exemption from the copayment, or are there documents required for private health insurance (PKV)?

Common Mistakes

Wait until the last day. Even if the prescription is still valid, the medication may not be in stock.

Don’t assume that a foreign prescription will always be accepted. The pharmacy is required to follow German regulations and may refuse to fill it.

Don’t confuse a green prescription with coverage by health insurance. A green form usually indicates a recommendation rather than a guarantee of reimbursement.

Don’t ask about generic alternatives. In Germany, medication substitutions are often governed by health insurance provider rules, but the pharmacist can explain the available options.

Buying controlled substances online without a pharmacy’s verification. For narcotics (BtM) and other strictly regulated medications, this carries the risk of counterfeit products and legal violations.