Facts
In September 2006, the company P. AG applied for the inclusion of the drug Champix with the active ingredient Varenicline in the Speciality List (SL) of the compulsory health insurance. The Federal Office of Public Health (FOPH) rejected the request, as the effectiveness, appropriateness and cost-effectiveness of the service had not been proven. The appellant P. AG then filed a complaint with the Federal Administrative Court, which was dismissed. Thereupon, P. AG filed a public law appeal with the Federal Supreme Court.
Considerations
The Federal Supreme Court partially upheld the appeal. It concluded that nicotine addiction is generally to be considered a condition requiring treatment within the meaning of the compulsory health insurance. However, certain conditions must be met, such as a minimum degree of nicotine dependence and the presence of initial signs of health impairment. Furthermore, nicotine addiction can also be a symptom or consequence of another illness, particularly a mental disorder.
Regarding the effectiveness of Champix, the Federal Supreme Court concluded that the proof of long-term efficacy can generally be considered as provided, as all studies have an observation period of 52 weeks. However, it must be examined whether the active ingredient Varenicline has been tested in persons with mental illnesses.
The Federal Supreme Court also affirmed the appropriateness of treatment with Champix. Champix is suitable to alleviate withdrawal symptoms and reduce nicotine…