Reimbursement

The revised EBM (German Uniform Evaluation Standard) catalog came into force on July 1, 2021. Three biomarker tests in breast cancer, a number of services related to cryopreservation of egg and sperm cells in young cancer patients, new services dedicated to prenatal testing of the fetal rhesus factor, services concerning the delivery of brachytherapy in prostate cancer were introduced.

On June 30, 2021, the Swiss Federal Council announced that the TARDOC outpatient tariff structure, presented by the association of insurers curafutura and the Swiss Medical Association (FMH), cannot be approved at this point. The Federal Council found the TARDOC tariff structure to have many drawbacks. Curafutura released an announcement in which they state that they will continue working on the TARDOC tariff structure and will try to implement as many changes as possible, according to the FOPH recommendations. This means that the TARDOC tariff structure is not likely to be implemented before January 2023.

On July 7, 2021, the Federal Joint Committee (G-BA) has launched an online database of method evaluations for conceptually new diagnostic and treatment methods (§135 SGB V), diagnostic and treatment methods in hospital settings (§137c SGB V) and within the framework of co-funded studies (§137e SGB V).

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in June 2021. Recommendations concern cardiovascular and peripheral vascular devices, orthopedic devices, liquid for embolization, and medical aids.

On June 19, 2021, two more health apps were introduced in the Directory of digital health applications (DiGAs) at the Federal Office for Drugs and Medical Devices (BfArM) and thus became reimbursable. These apps can be prescribed by physicians and psychotherapists and will be reimbursed by health insurers. In total, seventeen health apps are now available at the DiGA Directory.

On July 1, 2021, the updated version of the Swiss Services Ordinance (KLV/OPre) came into force. The changes concern the List of explicitly evaluated services (Annex 1 of KLV/OPre), the List of medical aids (Annex 2 of KLV/OPre), and the List of Analyses (Annex 3 of KLV/OPre).

On June 22, 2021, NHS England released 2019/20 National Cost Collection Data, which is a nationally mandated collection of cost data from secondary care and tertiary care providers that are delivering services in the NHS. The 2019/20 cost data is submitted by 208 NHS providers and gives the most comprehensive insight into how the sector spent £72.6 billion delivering healthcare to patients.

On May 27, 2021, the Ministry of Health released an Order with the updated list of organizations that provide high-end medical care. The list is expanded with the five new private facilities located in Stary Oskol, Kovrov, Vladivostok, Yekaterinburg, and Chita.

Transitional coverage of certain products and services (prise en charge (PEC) transitoire), according to article L165-1-5 of the Social Security, is a newly-established pathway to obtain reimbursement for CE-marked medical devices intended for the treatment of rare or serious diseases, or compensation for a disability. The coverage is provided for 12 months with an opportunity for renewal before submitting an application for inclusion in the List of Reimbursable Products and Services (LPPR).

In late May 2021, the Clinical Coding and Schedule Development (CCSD) working group, which develops and maintains procedural and diagnostics nomenclature for private payers in England, has published Bulletins 0177 and 0074 with changes to be implemented not later than August 01, 2021. Five new procedure codes related to diagnostic imaging, ENT, breast reconstruction, and gynecology, and nine new diagnostic codes were introduced.

The French National Authority for Health (HAS) released new recommendations about add-on reimbursement of medical devices and medical aids from the meetings of the National Commission for Evaluation of Medical Devices and Health Technologies (CNEDiMTS) in May 2021. Recommendations concern orthopedic devices, cardiovascular, peripheral vascular, and neurovascular devices, medical aids, and pulmonary artery pressure sensor.

The application portal for inclusion in the Health App Directory at the Federal Office for Drugs and Medical Devices (BfArM) in Germany has been online since May 27, 2020. The first reimbursable health apps were introduced on the Directory in early October 2020. As of May 27, 2021, a total of 74 applications were received, 51 of which for provisional listing and 23 for final listing. Fifteen applications (20%) were introduced on the Directory.