Federal Administrative Court, Decision C-7112/2017 of 26 September 2019

12. November 2019 – In a recent decision, the Federal Administrative Court held that the Federal Council’s implementation provisions (art. 65b para. 3, 4 and 4bis of the Ordinance on Health Care Insurance (SR 832.102) and art. 34abis of the Ordinance on Health Care Benefits (SR 832.112.31)) regarding foreign price comparisons (Auslandpreisvergleich; APV) and regarding therapeutic cross-comparisons (Therapeutischer Quervergleich; TQV) comply with the legal and constitutional requirements (criterion of economic efficiency of art. 32 para. 1 of the Health Care Insurance Act (SR 832.10) and principle of equality of art. 8 of the Swiss Federal Constitution (SR 101)). In the specific case, however, the Federal Office of Public Health (FOPH) wrongly included a – with regards to the main indication – non-comparable preparation in the TQV. Moreover, within the framework of the TQV, the FOPH carried out a simple gram respectively milliliter comparison without a corresponding legal basis or comprehensible justification, without further examining the effectiveness of the preparations to be compared and without determining the costs per day or cure. Accordingly, the Court revoked the contested order and referred the case back to the FOPH to carry out a new TQV and issue a new decision regarding the preparation at hand. For the full decision, see here.