Federal Supreme Court, Decision 9C_348/2021 of 26 August 2021

23 settembre 2021 – In this decision, the Federal Supreme Court had to rule on whether the refusal by Sanitas Grundversicherungen AG to cover the costs of the appellant's medicines from 1 January 2019 was admissible. The lower court had stated that the insured person had been prescribed medicines outside their registered indications and instructions for use (so-called "off-label use"). At the same time, it was neither apparent nor asserted that the administration of the disputed medicines outside the limits was an indispensable prerequisite for the provision of another service covered by the compulsory health insurance. In contrast, the appellant argued that it was no longer reimbursed for the prescribed medicines "overnight" without a sufficient adjustment and transition period in breach of good faith. However, the Federal Supreme Court could not agree with this argument and dismissed the appeal as clearly unfounded.

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