Refusal to reimburse medicinal products in individual cases under Article 71a et seq. KVV

A marketing authorization holder contacted us due to a dispute with a health insurance company in connection with the reimbursement of medicinal products in individual cases based on Article 71a et seq. of the Health Insurance Ordinance (KVV).

The health insurance company in question refused to reimburse a medicinal product that was used outside the indication listed in the specialities list (so-called off-label use) and demanded that the marketing authorization holder contribute to the outstanding costs.

In this context, the question also arose as to whether medicinal products that are used off-label can also be reimbursed in the outpatient sector on the basis of Article 71a et seq. KVV.

After various correspondence, we were able to reach an agreement with the health insurance company.