Facts
In 2003, the rare disease paroxysmal nocturnal hemoglobinuria (PNH) was diagnosed in N., born in 1942. Since 2005, she has been receiving the medication Soliris, which has been approved in Switzerland since January 4, 2010. From September 2005 to April 2008, the treatment was carried out as part of an international study and subsequently under "Compassionate Use" with special authorization. From May 2009, the basic insurance (Progrès Insurances AG) covered the costs for the treatment with Soliris. In April 2010, however, Progrès denied any further entitlement to benefits from the time of the approval of Soliris on January 4, 2010. The insured person filed a complaint against this.Considerations
The Federal Supreme Court ruled that the cost coverage for the medication Soliris by the basic insurance cannot be refused solely on the basis of the approval by Swissmedic. The case law provides for exceptions to the obligation to be included in the list if, for a disease that can be fatal or lead to severe and chronic health problems for the insured person, there is no other effective treatment method available due to a lack of therapeutic alternatives and the drug has a…