How to Implement the E-Rezept in Your Pharmacy: Step-by-Step Guide (2026)
This guide walks through the complete E-Rezept implementation process — what you need, in what order, and what's changing in 2026 that every pharmacy owner should already be aware of. Whether you're starting from scratch or auditing your current setup, this is your checklist.
Before You Start: Understand What 'Implementation' Actually Means
Most guides stop at 'get connected to the TI.' That's Step 1 of many. A fully implemented E-Rezept setup covers five layers:
Most pharmacies in Germany have Layer 1 covered. Layers 2–5 are where the gaps usually are — and where patient experience and operational efficiency live.
Step 1: Connect to the Telematikinfrastruktur (TI)
The Telematikinfrastruktur is Germany's secure national health data network, operated by gematik GmbH. Without a TI connection, your pharmacy cannot access the E-Rezept-Fachdienst — the central server where prescriptions are stored.
A certified connector (Konnektor)
The hardware router that creates your secure connection to the TI. Must be gematik-certified. Main providers include RISE, CGM, and secunet.
SMC-B card (Institutionskarte)
Your pharmacy's institutional identity card, issued by your regional pharmacy association. Required to authenticate your pharmacy on the TI.
eHBA (elektronischer Heilberufsausweis)
The electronic professional ID for your pharmacist(s). Also required for certain TI transactions.
A certified card terminal
To read patients' electronic health cards (eGK) at the counter. At least one per dispensing point.
Stable internet connection
The TI connector requires a reliable broadband connection.
Financing:
Pharmacies are entitled to a one-time TI setup allowance as well as ongoing monthly operating cost reimbursements. Contact your regional pharmacy association or your AVS provider for the current figures.
1. Connectors (January 1, 2026): RSA-only connectors lost TI access as of January 1, 2026. There is no grace period. 2. SMC-B cards (June 30, 2026): Generation 2.0 must be replaced with ECC-capable generation 2.1 by June 30, 2026. 3. eHBA cards (June 30, 2026): Generation 2.0 must also be replaced by June 30, 2026.
Step 2: Update Your Pharmacy Management System (AVS)
Your Apothekenverwaltungssystem (AVS) is the software your team uses to manage prescriptions. If your AVS has not been updated to handle all three E-Rezept redemption paths, contact your provider immediately. What your updated AVS should handle: • Retrieve prescriptions from the E-Rezept-Fachdienst via all three redemption methods • Display pending prescriptions when a patient's eGK is inserted • Mark prescriptions as redeemed automatically after dispensing • Log all E-Rezept transactions for audit and billing purposes • Support ePA access — mandatory since October 2025
Step 3: Set Up Your Card Terminal Correctly
A certified card terminal at the dispensing counter is mandatory for processing E-Rezepts via the electronic health card (eGK).
Positioning
The terminal should be accessible to both the pharmacist and the patient at the counter.
Multiple counters
If your pharmacy has more than one dispensing point, you need a certified terminal at each.
Firmware updates
Card terminals require regular firmware updates to remain gematik-certified.
Staff familiarity
Every member of staff who handles prescriptions should be able to operate the terminal confidently.
Step 4: Train Your Team — All Three Redemption Paths
This is the step most pharmacy owners underinvest in. Your team needs to handle all three E-Rezept redemption paths smoothly:
Path 1 — Electronic Health Card (eGK)
Patient hands over their Gesundheitskarte. Staff insert it into the terminal. Pending prescriptions appear in the AVS.
Path 2 — E-Rezept App QR Code
Patient shows a QR code in the E-Rezept app. Staff scan it using the terminal or connected scanner. Staff should know how to guide patients who are confused.
Path 3 — Paper Printout with QR Code
Patient presents a printed sheet with a QR code. Staff scan it. Remind staff this is not the old pink prescription, just a digital token.
Step 5: Prepare a TI Outage Protocol
The E-Rezept system has experienced outages. Your pharmacy needs a documented fallback protocol for when the TI connection is unavailable: • Communicate clearly to patients that the system is temporarily unavailable (not that their prescription is missing) • Know which prescriptions can legally be processed on a paper fallback basis • Have your TI provider's emergency contact number accessible • Log every outage incident with time, duration, and patient impact
Step 6: Communicate the Change to Your Patients
Many patients are still unsure how the E-Rezept works. Practical patient communication steps: • In-store signage: A simple poster explaining the three redemption options. • Staff briefing: Train staff on the 5 most common patient questions. • Digital touchpoints: Include a clear E-Rezept guide on your website or app.
What's Coming Next: 2026 Deadlines to Know
July 1, 2026 — E-Rezept mandatory for home care
Electronic prescriptions become mandatory for häusliche Krankenpflege (home nursing care) and außerklinische Intensivpflege (outpatient intensive care).
July 2026 — eMP in ePA
The next ePA expansion adds the elektronischer Medikationsplan (eMP). Pharmacies will be able to view and update complete medication lists.
August 2026–January 2027 — CardLink replaced by PoPP
CardLink is a transitional technology being phased out in favour of PoPP (Proof of Patient Presence). CardLink is fully retired by January 31, 2027.
The Implementation Checklist
Technical infrastructure
Operations & compliance
Patient experience
Upcoming deadlines
A Note on Patient-Facing Digital Infrastructure
The TI connection and AVS update cover what happens inside your pharmacy. What they don't cover is how patients interact with your pharmacy digitally. Pharmacies building digital touchpoints — a pharmacy app, Click & Collect, digital appointment booking — are creating a layer of convenience that standalone TI compliance doesn't deliver. Platforms like Mediloon provide this as a complete package built specifically for German pharmacies.
About Mediloon
Mediloon is a Leipzig-based healthtech company building digital infrastructure for German pharmacies — including E-Rezept integration, pharmacy apps, Click & Collect, Botendienst coordination, and the Medi AI assistant. This article is part of Mediloon's pharmacy digitalisation guide series. It is intended as general operational and regulatory information. For specific legal or compliance queries relating to AI systems in your pharmacy, consult your regional Apothekerkammer or a qualified legal advisor.