Federal Administrative Court, Decision C-415/2020 from 16 November 2021
26. November 2021 – In its decision, the court had to examine the legality of the limitation of appellant’s medicinal product. The Court clarified that the Federal Office of Public Health (FOPH) could narrow down the indication and application instructions as authorised by Swissmedic by limitations pursuant to art. 73 Ordinance on Health Insurance. The limitation in question was legal according to the Court. In this context, the court held that the contested limitation undisputedly implemented the treatment recommendation according to a guideline, which was based on a broadly supported, experience-based expert consensus. Accordingly, the limitation was objectively justified and ensured that the medicinal product in question was not used at the expense of the OKP on patients who according to the expert consensus would benefit more from other therapies.
Therefore, the Court dismissed the appeal.
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