Facts
This case was about the question of whether the health insurance company Avenir Assurances, as the Tiers payant, owes the reimbursement for medications that the patient [A.] had obtained at the pharmacy [X.] according to a magistral prescription, or whether this reimbursement can be refused due to a violation of the principle of economic efficiency.
The pharmacy [X.] had invoiced the health insurance company Avenir Assurances a total of CHF 59,524.25 for the medications obtained from June to November 2004, of which the health insurance company only covered CHF 2,486.25. The pharmacy then filed a lawsuit against the health insurance company for payment of the remaining amount of CHF 57,038.-.
Considerations
The Federal Supreme Court decided that the pharmacist is not obliged, either by law or by the tariff agreement, to examine the economic efficiency of the medication prescribed by the treating physician. The health insurance company as the Tiers payant must therefore reimburse the…