The ad hoc reimbursement of medicines under Articles 71a to 71d KVV gives patients important access to life-saving therapies that have not yet been approved. However, requests for reimbursement have increased considerably in recent years and can no longer be considered ‘exceptional’. CSS therefore welcomes the federal government’s efforts to optimise the processes for assessing ad hoc cases and reducing the number of cases in this area.
To once more make ad hoc case assessments the exception rather than the rule, CSS is calling for two things to happen:
- On the one hand, the scope of Articles 71a to 71d KVV should be limited to medical conditions which, if not treated immediately, will in all probability lead to the death of the insured person or leave their health seriously and chronically impaired.
- On the other hand, the refunding of cases under Article 71b should be limited to two years in order to give the industry more of an incentive to submit applications for their products to be included on the Specialties List.
CSS takes a critical view of the idea of making high, fixed discounts dependent on a therapy’s benefit. Fundamental questions arise regarding the enforceability of such discounts, given that the licence holders are not service providers as defined by the KVG. Licence holders will exert more and more pressure on the assessment of the benefits by medical officers in order to achieve a better outcome for themselves and thus have to contribute less to the cost. In addition, there is a risk that fixed price discounts will make patients' access to life-saving therapies more difficult as companies will either insist on their previous pricing expectations or withdraw completely from the Swiss market and no longer offer the respective product in Switzerland.
CSS prefers prices to be set through negotiations with the pharmaceutical companies. At present, framework contracts are used to implement Art. 71a-71d KVV. Many of these cases, especially those falling under Art. 71a and Art. 71b KVV, can be implemented and handled quickly, easily and in the interests of patients.