The court upheld the appeal of VšZP in the case of payment of medicine to a child patient with SMA – Domestic – News

The Regional Court in Bratislava upheld the appeal of the state General Health Insurance Company (VšZP) in the case of reimbursement of the drug Zolgensma to a child patient with spinal muscular atrophy (SMA) II. type. This was confirmed by Ivana Štefúnová from the VšZP communication department for TASR, the portal ozdravme.sk drew attention to it.

In March, the District Court of Bratislava V ordered the payment of the two-million-dollar medicine for the exception of the health insurance company in an urgent measure.

“The regional court changed the decision of the court of first instance and rejected the plaintiff’s proposal to order an urgent measure, thus confirming that the conditions for ordering it, and thus for the payment of the medicine, were not met. VšZP is reviewing the next steps,” she said.

VšZP does not register any other urgent measures for payment of uncategorized medicine. He believes that the court’s decision will contribute to the fact that medicines for exemption are approved exclusively according to the conditions that health insurance companies must comply with, and not under media and public pressure.

She declared that it is in her interest that all patients who can be helped have access to innovative medicines. “However, the options of health insurance companies are significantly limited by the budget and the set limits for uncategorized medicines, which the Ministry of Health should change without delay, through categorization or by creating a separate fund from which health insurance companies will be able to draw on exceptions until they enter the categorization,” she added. Štefúnová.

This year, the state health insurance company reimbursed Zolgensma to two more insured persons. She pointed out that they were diagnosed with type 1 SMA immediately after birth thanks to a pilot newborn screening. “VšZP granted the request for this drug, as based on medical evidence, the best treatment results can be achieved in patients with type 1 SMA when the drug is given to them before the 42nd day after birth,” pointed out Štefúnová.

VšZP declared that it supports the initiative of the Ministry of Health to make screening for the diagnosis of SMA a regular part of newborn screening covered by public health insurance. “At the same time, he is of the opinion that if treatment with a certain drug becomes the standard and only therapeutic alternative, the drug should be categorized and available to every patient who meets the indication criteria,” she added.