Federal Administrative Court, Decision C-5976/2018 of 15 April 2020

12 May 2020 – In a recent decision, the Federal Administrative Court held that an exception under article 65d para. 3 Health Insurance Ordinance (KVV) cannot be justified solely by the fact that a dose level other than the lowest is used more frequently. Since in the present case, according to expert information, the lowest dosage (25 mg) is not only used at the beginning of the therapy, no exceptions according to the Manual SL or Art. 65d para. 3 KVV are apparent. The Federal Administrative Court therefore concluded that the TQV carried out by the lower instance is reasonable, factually sound and comprehensible. Furthermore, the Federal Administrative Court denied the existence of a violation of the requirement for equal treatment of the members of the same industry, since the TQV was carried out for all schizophrenia drugs in the same way as in the present case. The appeal is dismissed. For the full decision, see: https://jurispub.admin.ch/publiws/download?decisionId=adcf1723-0661-4095-b464-afabb8349980.