Reimbursement

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 September 2021. In total, 58 recommendations for registration, modification of registration conditions, and removal of devices from the List of reimbursable products and services (LPPR) were published. Opinions concern cardiovascular, orthopedic, peripheral vascular, and other groups of devices, as well as medical aids.

On September 30, 2021, the 2020/21 National Tariff Payment System was published in England, and it came into effect on October 01, 2021. The publication has been delayed due to the COVID-19 pandemic.

On September 10, 2021, it was announced that the Government of Spain had increased the budget allocated to the Spanish Network of Agencies for the Evaluation of Health Technologies and Benefits (RedETS) by 48.2% (compared to last year) for the development of the annual work plan. In total, the 2021 budget for the evaluation of health technologies in the National Health System amounts to €6,149,510. As a consequence of the budget increase, the RedETS 2021 Work Plan has included three new lines of evaluation.

On August 26, 2021, the Dutch Healthcare Authority (NZa) published the fourth release of the DRG package for the year 2021 (RZ21d).

At the beginning of September 2021, the Government of the Russian Federation released the preliminary version of the Program of State Guarantees for the period of 2022-2024. Major changes concerned the High-End Medical Care (HEMC) list I, where two new procedures in the cardiovascular and neurovascular field were added. The HEMC list II was expanded with the procedures in the field of radiotherapy, neurology, and neurosurgery, surgical procedures. The final version is expected at the beginning of 2022.

On August 30, 2021, the Decision Forum for "New Methods" made a positive coverage decision for two methods: Transurethral Microwave Thermotherapy (TUMT) for benign prostatic hyperplasia treatment and organ donation using normothermic regional perfusion in patients with severe brain injury and who died of cardiac and respiratory arrest when life-prolonging treatment is discontinued.

On August 16, 2021, the preliminary version of OPS 2022 was published. Numerous content updates and new procedure codes concern chapters 5 “Operations” and 8 “Non-operative therapeutic measures”. Also, minor changes were made in chapters 1, “Diagnostic measures” and 3, “Diagnostic imaging”.New codes were introduced in the peripheral vascular, cardiovascular, nephrology and urology, endoscopy, gastroenterology, otorhinolaryngology, interventional radiology, orthopedics, pulmonary and airways, and other fields of care.

Certain medical devices are financed within the DRG tariff but require explicit review to ensure that they are safe and effective. This mechanism is called “intra-DRG” (intra-GHS) coverage. On August 5, 2021, the new version of the intra-DRG list was published by the French Ministry of Solidarity and Health. No new devices were added to the list compared to the version of November 2020.

On August 11, 2021, the Dutch Healthcare Institute (ZIN) published the assessment of Oncotype DX®. The assessment was conducted to confirm whether the test complies with the criteria of "science and practice" to determine if it can be reimbursed under the basic health insurance package. In conclusion, the test can be reimbursed under the basic health insurance package.

On July 30, 2021, the final version of the French DRG manual was published on the website of the Technical Agency for Information on Hospitalizations (ATIH). No new DRGs or other changes compared to the preliminary version published in March 2021 have been introduced.

In late July 2021, NHS England opened a call for applications to the High Cost Device List (HCDL) changes for the 2022/23 National Tariff Payment System. The completed application form should be submitted via email by September 30, 2021. HCDL is an add-on reimbursement for medical devices and in-vitro diagnostic tests, so the amount is paid in addition to the payment for regular care.

On July 30, 2021, the Swiss Federal Statistics Office (UFS) published the 2022 version of the procedure code (CHOP) nomenclature in the German language. The newly introduced codes concern various technology groups, such as cardiovascular, gastrointestinal, neurology, interventional radiology, orthopedics, gynecology, and others.