Federal Supreme Court, Decision 9C_563/2020 of 7 June 2021

8 juillet 2021 – In this decision, the Federal Supreme Court had to assess whether the lower court violated federal law by confirming the reduction in the price of the appellant's medicine ordered by the Federal Office of Public Health (FOPH). The appellant objected to the Therapeutic Cross-Comparison (TQV) carried out by the FOPH. In its view, the FOPH abused its discretion by basing the TQV on a comparative medicine without patent protection.

After a thorough examination, the Federal Supreme Court held that neither the lower court nor the FOPH had exercised their discretion improperly or arbitrarily by denying a therapeutic progress of the appellant's medicine in comparison with another patent-protected medicine listed in the list of specialities (SL) in accordance with art. 65b para. 6 of the Ordinance on health insurance (KVV) due to the lack of scientific evidence. The question of how significant a proven therapeutic progress must be in order for it to be taken into account in the assessment of the cost-effectiveness of a successor product, or how this differs qualitatively from "significant therapeutic progress" under art. 65b para. 7 KVV respectively, could therefore be left open. Consequently, the appeal was dismissed.

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