Social Security Court of the Canton of Zurich, Decision KV.2019.00040 of 31 October 2019

19. November 2019 – The Social Security Court of the Canton of Zurich approved an appeal against the decision of a health care insurance company rejecting a cost reimbursement request for the treatment a patient suffering from a recurrent multiple myeloma with a combination therapy consisting of Darzalex/Revlimid/Dexamethasone. The given combination is not listed in the list of specialties (off label use). However, the Court held that the requirements of art. 71a of the Ordinance on Health Care Insurance (KVV; SR 832.102) are met and affirmed that no other effective treatment is available and that the therapy combination at hand has a high therapeutic benefit. Therefore, the appeal was approved with the finding that the insurance company is obliged to cover the costs of the appellant’s off label treatment. For the full decision, see here.