The German healthcare system had introduced copayments in the late 1990s in an attempt to prevent overutilization and control costs.
For example, Techniker Krankenkasse-insured members above 18 years pay the copayments costs for some medicines, therapeutic measures and appliances such as physiotherapy and hearing aids up to the limit of 2% of the family's annual gross income.
Occasionally if a non-generic drug is reduced in price insurers will agree to classify it as generic for copayment purposes (as occurred with simvastatin).
Thereafter, if a patient is still taking the brand name medication, the pharmaceutical companies might remove the option and require full payments.
[10] In a 2007 meta-analysis, RAND researchers concluded that higher copayments were associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy.