Federal Social Court: Mistletoe preparations: Health insurance companies should pay for palliative use

Federal Social Court: Mistletoe preparations: Health insurance companies should pay for palliative use

No costs for mistletoe therapy outside of palliative therapy
The active ingredients of mistletoe can have an extremely positive effect in the treatment of cancer. Therefore, a woman had sued her health insurance company for the cost of adjuvant cancer therapy with the anthroposophic, non-prescription drug Iscador M. However, the responsible social court dismissed the complaint and at the federal social court the filed appeal was rejected at a hearing on December 15 (file number: B 1 KR 30/15 R). "Health insurance companies only have to pay for palliative anthroposophic mistletoe preparations," said the Federal Social Court's decision on the decision.

After her health insurance company refused to cover the costs of the anthroposophical, non-prescription drug Iscador M, the cancer patient filed a lawsuit with the responsible social court. However, this decided against the applicant. The woman has now also failed in the appeal at the Federal Social Court. The advantages of mistletoe therapy for cancer are well known, but according to the Federal Social Court, “pharmacy-only, non-prescription medicines such as the mistletoe preparation Iscador M are basically excluded from the supply of medicines in accordance with SGB V.” The assumption of costs is limited to use in palliative medicine.

No claim to the supply of anthroposophical mistletoe preparations
The recommendation of the Federal Joint Committee (GBA) forms the basis for the assumption of costs for medicinal products. However, the GBA included the mistletoe preparations "only limited to their use in palliative therapy in the list of prescription-free, non-prescription medicines", reports the Federal Social Court. The plaintiff's appeal has been dismissed, according to the court's notice, and she is not eligible for the non-prescription drug Iscador M for adjuvant cancer therapy. According to the Federal Social Court, the restriction of use “in palliative therapy” also applies to medicinal products of the special therapeutic directions.

The Federal Social Court justifies its decision, among other things, by the fact that the GBA has sufficient democratic legitimacy to lay down guidelines for which non-prescription medicines in the case of serious illnesses can be prescribed by way of exception - with a corresponding contractual medical justification. (fp)

Author and source information

Video: What Makes Medicare A Lucrative Business?