The list of items covered by compulsory health insurance does not currently include any medicinal cannabis products. Although efficacy has been shown for certain finished medicinal products in specific indications (FOPH HTA report), the criteria required for listing (efficacy, appropriateness and cost-effectiveness), and thus reimbursement, have not yet been deemed to be met. For this reason, reimbursement under compulsory health insurance may only be possible if, inter alia, use of the medicinal product is an indispensable prerequisite for the provision of a different service which is covered by compulsory health insurance and is clearly the priority concern; or if use of the medicinal product is expected to provide a major therapeutic benefit in a condition which may be fatal or lead to severe and chronic health impairments for the person insured and, owing to a lack of therapeutic alternatives, no other effective and authorised treatment method is available (so-called reimbursement on an individual basis, Art. 71a ff. of the Health Insurance Ordinance of 27 June 1995 [KVV]). According to the HTA report, however, a major therapeutic benefit is not to be expected even with the finished medicinal products. Reimbursement on an individual basis always also requires prior confirmation from the health insurer. With appropriate coverage, however, reimbursement may have to be provided under supplementary insurance.
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