Update on reimbursement rates for innovative medicines
The drugs Tisagenlecleucel and Axikabtagene-ciloleucel, reported by medical procedures with codes 64335.1 64335.2 by inpatient health care providers, are defined by Type A reimbursement in the 2023 Case Fee Schedule, i.e., they have a fixed reimbursement. From 1.8.2023 these medicines will be included in the Categorised Medicines List. From 1.8.2023, these medicines are covered by the Contract on the terms of reimbursement of the medicine signed by the Ministry of Health of the Slovak Republic and the holder of the registration pursuant to Section 7a of Act No. 363/2011 Coll. on the scope and conditions of reimbursement of medicines, medical devices and dietetic foods on the basis of the public health insurance and on the amendment and supplementation of certain acts.
The amount of reimbursement of medicinal products established by the Contract on the terms and conditions of reimbursement of medicinal products between the Ministry of Health of the Slovak Republic and the holder of the medicinal product registration shall take precedence over the amount of reimbursement established by the Catalogue of case lump sums. As this is a new procedural procedure and the Catalogue of Case Rates for 2023 has not been prepared with regard to the Agreements on the Conditions of Reimbursement of Medicinal Products, we hereby direct the users of the SK-DRG system that the Catalogue of Case Rates should not be used in the part of the prices and reimbursement of Tisagenlecleucel and Axikabtagén-ciloleucel, respectively.
As of 2024, the Catalogue of case lump sums for these and other medicines for innovative treatment included in the List of categorised medicinal products intended for provision in institutional care will include a separate new type of reimbursement, which will be characterised not by the determination of a specific reimbursement, but by a reference to the reimbursement set out in the Contract on the terms and conditions of reimbursement of the medicinal product between the Ministry of Health of the Slovak Republic and the holder of the marketing authorisation for the medicinal product.