There are shocking treatment inequalities between patients when it comes to reimbursing used off-label drugs. The revision of the ordering provisions is often so urgent that it is necessary.
Thomas Cerny, an oncologist and member of the committee of the Swiss Cancer League, is convinced that “the off-label (off label) will be the standard in oncology in the future ”. Already today, about one-third of all adults with cancer and almost all affected children receive drugs in use. off-label, that is, outside the permitted indications, e.g. In the case of particular cases provided for in Articles 71A the 71d of the Medicare Ordinance (OAMal) is therefore no longer an exceptional regulation. Accelerating medical progress and precision medicine will further increase off-label uses.
The current legal regulations are outdated
Pour la Ligue contre le cancer, it is essential for people with cancer to have quick and equitable access to vital treatments. That is why their reimbursement must also be fair and strictly regulated for all health insurers. Articles 71A the 71d of the OAMal define the conditions in that off-label treatment must be reimbursed by the compulsory care insurance. Through a request for cost relief, it is possible, in special cases, to prescribe a drug to people with life-threatening illnesses outside of an authorized indication. To the extent that a high therapeutic benefit is expected and no equivalent alternative is allowed, it must be reimbursed. However, the system – originally intended as an exceptional regime – also has weaknesses.
Patients are in a weak position
In the field of oncology, health insurers accept an average of 75% of cost claims. For the other, mostly complex, cases, an FOPH evaluation report reported inequality of treatment in reimbursement — a phenomenon that patient organizations such as the Cancer League have long denounced. years. If the health insurance company refuses to cover you, the costs, which can reach several hundred thousand francs, are currently borne by the affected people and their families, so they are out of reach for most of the people involved. Health insurance decisions are sometimes opaque and patients have no recourse, if not through legal, lengthy and costly means. Added to this is a significant administrative fee: on the one hand for oncologists who submit the application and on the other hand for health insurers who evaluate it. Finally, the time factor plays an important role, and the duration of treatment of an application can be decisive, especially in the case of cancer.
The Cancer League is committed to greater equity in access to care
“Making access to off-label treatments more equitable requires consolidating the binding dimension and standardizing processes,” said Franziska Lenz, Head of Policy and Public Affairs at the Swiss Cancer League. La Ligue contre le cancer therefore welcomes the review of the legal basis and is actively engaged in the ongoing consultation to defend the interests of patients. In addition, it is working with Oncosuisse and other partners to take additional measures to ensure that affected people have quick and equitable access to off-label uses. A national register including a digital platform for depositing applications, enhancing transparency when filing claims, and a central service for assessing profit in complex cases are among the measures advocated.
Contact Stefanie de Borba Responsable médias Ligue suisse contre le cancer [email protected] T +41 31 389 93 31
to Swiss Cancer League is a non-profit organization that has been working in cancer prevention, research promotion, and support for people with cancer and their loved ones for 111 years. As a national umbrella organization based in Bern, it brings together 18 cantonal and regional leagues. ZEWO certified, it is mainly funded by donations.