26 April 2024 – In its decision of 18 March 2024, the Federal Supreme Court dismissed the appeal of CSS Kranken-Versicherung AG (CSS) against the decision of the Cantonal Arbitration Court for Health Insurance Disputes of the Canton of Basel-Stadt regarding the invoicing of the ALT (medicines list with tariff, Arzneimittelliste mit Tarif) charge for the preparation of cytostatics by Hospital A.

The court primarily addressed the question whether the ALT charge for cytostatic preparation could be invoiced by Hospital A. to the compulsory health insurance. The medicines list with tariff (ALT) is a list of products and active substances and excipients used in extemporaneous preparation, with the corresponding tariffs.

In Chapter II, the ALT List determines the tariff for certain services provided by pharmacists. Litera D of Chapter II lists aseptic preparation (complete parenteral nutrient solution, "TPN") and defines the requirements that a processing procedure must meet for corresponding charge compensation to be granted. This includes aseptic manufacturing according to good manufacturing practice (" GMP") in a qualified work unit for cytostatics by an institution with a manufacturing permit in this regard.

The court held that the preparation of cytostatic infusions by the hospital pharmacy of Hospital A. fell under the term "manufacturing" within the meaning of Art. 4 para. 1 lit. c of the Therapeutic Products Act (TPA) and that the preparation of cytostatic infusions was carried out according to the rules of Good Manufacturing Practice for medicinal products in small quantities according to Annex 2 of the Pharmacopoea Helvetica (Ph. Helv.).

As it was undisputed that the hospital pharmacy of Hospital A. had the necessary manufacturing permit, the court concluded that invoicing the ALT charge for cytostatic preparation by Hospital A. was permissible at the expense of the compulsory health insurance.

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