Ad hoc reimbursement of medicines in accordance with Articles 71a to 71d KVV
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. The revision of the KLV/KVV that came into effect on 1 January 2024 sought to reduce the administrative burden and harmonise implementation, while at the same time increasing equality of access. Applications for reimbursement have risen sharply since the beginning of 2024. The expected optimisation effect has not yet been achieved with regard to administration. Health insurers' power to negotiate over high-priced therapies has been removed and replaced by fixed price discounts. Nevertheless, more and more requests are being turned down as certain manufacturers refuse to accept the fixed price discounts. According to current assessments, the aim of getting manufacturers to place expensive pharmaceuticals on the SL sooner by means of high discounts is only being partly achieved.
To once more make ad hoc case assessments the exception rather than the rule, CSS is calling for the following:
- 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 reimbursement of cases under Articles 71b and c KVV should be limited to a maximum of 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.
- In addition, CSS would like to see an effectiveness report in the form of implementation controls along with a cost evaluation by the Federal government.
Your health partner
As a health partner, we are committed to leading a healthy life, actively taking steps to regain one's health and developing a mindful approach to illness.
