For patients at risk, the rule remains: stay at home! Regular medical checks as a prerequisite for the reimbursement of certain medications are thus no longer required. The FOPH is therefore asking health insurers to be accommodating.
In the context of inclusion on the list of specialties, the Federal Office of Public Health (FOPH) may restrict the indications approved by Swissmedic by imposing limits. However, given the current situation, it may be difficult to comply with the requirements and conditions set by the FOPH in limitations for all medicines. On the one hand, some of the persons affected belong to the vulnerable group with an increased risk of serious consequences in the event of a coronavirus infection and, on the other hand, the capacities of the treating physicians are partially limited. For example, in the case of some drugs, the control examinations required for a renewed approval of costs cannot currently be performed in a timely manner. In addition, for certain drugs, it may be useful to adjust the therapeutic regimens provided in the professional information in order to reduce the number of visits to the doctor.
Therefore, the FOPH addresses the associations of health insurers: “We therefore ask you to take the current situation into account when reviewing corresponding applications from service providers. We ask you, from a medical-pharmaceutical point of view, to evaluate and decide on sensible therapies or applications that take the current situation into account, pragmatically and with the necessary goodwill.”
Source: www.bag.admin.ch
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Amgen assists with reporting to insurers Due to current public policy restrictions, certain reimbursement guidelines for PCSK9 inhibitors, such as Repatha® (evolocumab), may be difficult or impossible to meet. This concerns in particular the following passages of the Limitatio: “After approval of costs by the health insurer after prior consultation with the medical examiner.” “Treatment may be continued only if, at follow-up within 6 months of treatment initiation, LDL-C has been reduced by at least 40% from baseline on maximally intensified lipid-lowering therapy or an LDL level of less than 1.8 mmol/l has been achieved (excluding homozygous familial hypercholesterolemia). “1 Despite positive approval of the costs of Repatha® therapy, it may be that for organizational reasons the therapy cannot be started as planned at present. As a result, the performance review cannot take place within 6 months as usual. Even if therapy has already been started, there may be an organizational delay in monitoring success. Amgen has discussed this situation with health insurer officials. They offer the following solution: Please inform the responsible health insurance company of the Repatha® patient in case of a delayed start of therapy or a due success control, which cannot take place due to organizational reasons. To make your work easier, Amgen provides you with a letter with 2 text modules that you can use as a template for reporting to the insurers. You can download the letter 1. list of specialties from the Federal Office of Public Health, www.spezialitätenliste.ch |
References and brief subject info
CH-REP-0520-00004 (04/2020)
