Facts
[A.], born in 1934, has suffered from a severe eye disease (Stevens-Johnson reaction or Lyell's syndrome) since 2008, which has led to massive damage to the surface of the eyes and blindness in the left eye. To stabilize the situation in the right eye, the treating physician prescribed [A.] autologous serum eye drops. The health insurance company Atupri refused to cover the costs of these drops, as they are not listed in the Specialty List (SL). However, the cantonal court obliged Atupri to cover the costs. Atupri and the Federal Office of Public Health (BAG) appealed the cantonal decision to the Federal Supreme Court.Considerations
The Federal Supreme Court dismisses the appeals and confirms that the autologous serum eye drops must be covered by the mandatory health insurance in the present case. The decisive factor is that the serum eye drops are to be classified as a magistral preparation, which, although not listed in the SL, are nevertheless considered ready-to-use medicinal products within the meaning of Art. 71b para. 1 of the Health Insurance Benefits Ordinance…