Refusal of reimbursement for medicinal products in individual cases in accordance with Article 71a ff. of the 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.

The health insurance company in question refused to reimburse a drug that was used outside the indication listed in the specialty 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 drugs that are used off-label can also be reimbursed in the outpatient sector on the basis of Article 71a ff. of the KVV.

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