Apps on prescription: E-prescription process works in tests, usage remains low

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In the TI model region in Hamburg and surrounding areas, gematik, together with medical practices, software providers, and health insurance companies, tested the e-prescription process for digital health applications (DiGA) under real conditions for the first time. Between May and September 2025, ten service provider institutions and 13 health insurance companies participated in the pilot phase. The goal was to test the work processes surrounding the new digital prescriptions for DiGAs technically and organizationally.

Redemption remains a hurdle for insured persons

The final report from gematik (PDF) attests the process "high technical stability, performance, and reliability, regardless of the practice management systems used." Furthermore, the "integration into existing workflows went smoothly, and the process could be used in the primary system without significant training effort." The function "DiGA as e-prescription" was also consistently available in all PVS. A total of 119 digital prescriptions were issued, but the majority (91) were not redeemed by patients. Only 15 DiGAs were redeemed by insured persons via the gematik e-prescription app or the health insurance app -- 13 via the e-prescription paper token.

According to the report, many failed due to the complex authentication in the apps or decided to redeem them with a delay. Doctors reported that the digital process was still unfamiliar to many insured persons and that simplified procedures would be desirable.

According to gematik, doctors wished for clearer information in the practice management system and for patients. In particular, the printout of the e-prescription token caused confusion, as it visually strongly resembled classic medication prescriptions. The model region team has therefore developed a new layout proposal with clear labeling and a more understandable redemption guide. In the future, it should also be visible which health insurance companies already support electronic prescriptions for DiGA.

The technical foundation for the nationwide introduction of DiGA e-prescriptions has been laid, although challenges remain regarding the user-friendliness of the apps and the awareness of digital care services. "Digitalization in healthcare succeeds when technology, user-friendliness, and patient orientation work together," states gematik's conclusion. Since July 2025, insured persons can also request their activation codes directly in the health insurance companies' ePA apps – another step towards fully digital prescriptions.

Association warns of improvements

Despite the overall positive assessment, the Spitzenverband Digitale Gesundheitsversorgung (SDGVS) sees a significant need for further action before the e-prescription for DiGA is rolled out nationwide. In a statement, the association explained that while the pilot project showed that the technical framework is in place, the processes for doctors and insured persons are still too complex. Redemption via multiple apps or paper printouts is not in line with a consistently digital care pathway. The association has "already presented a practice-oriented alternative and is advocating for a patient-centered, low-threshold, and barrier-free process that ensures access to DiGA care while simultaneously reducing administrative burdens in medical practices."

"Redemption path too cumbersome"

In the run-up, there had repeatedly been criticism from the SVDGV. For example, it had criticized that despite the legally stipulated deadline of two working days, it took an average of around 14 days for insured persons to receive their activation code from the health insurance company. The SVDGV therefore demands that patients be able to use their apps on prescription directly in the future – digitally, without manual code entry, and regardless of whether they use the e-prescription app or the ePA. Only then can the DiGA approach truly fulfill its original idea of barrier-reduced, digital healthcare.

And even before that, the association was furious, as health insurance companies had been complaining about the high costs of apps on prescription for years. In spring 2025, the association accused health insurance companies of being biased and defended the DiGA system as an international success model. The unique regulation and the fast-track procedure in Germany, according to the association, "bring innovation into care and offer patients real added value."

(mack)