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Reimbursement summary for angioplasty of arteries of lower extremities

This post presents an extract from our reimbursement analysis for angioplasty of arteries lower extremities using plain and drug-coated balloons (DCBs) for peripheral artery disease in England, France and Germany. Plain balloon angioplasty is reimbursement via DRG solely and DCBs are reimbursement via combination of DRG and add-on reimbursement.
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Swiss Services Ordinance (KLV/OPre) updated on July 1, 2021

On July 1, 2021, the updated version of the Swiss Services Ordinance (KLV/OPre) came into force. The following documents were released:

  • The updated Swiss Services Ordinance (KLV/OPre) document, versions of July 1, 2021, of October 1, 2021, of January 1, 2022. The changes include mostly wording changes;
  • The updated Annex 1 of KLV/OPre (explicitly evaluated services), version of July 1, 2021;
  • The updated Annex 3 of KLV/OPre (List of Analyses), version of July 1, 2021;
  • The updated Annex 2 of KLV OPre (List of Medical Aids), versions of June 1, 2021, of July 1, 2021, of October 1, 2021, of January 1, 2022.

Annex 1 of the Services Ordinance (KLV/OPre), which contains the List of services explicitly evaluated for coverage, can be found here. Some examples of the introduced updates are provided below:

  • Changes happened in the limitations for delivering “local deep oncological hyperthermia in combination with external radiotherapy or brachytherapy”. For treating cervical cancer, pancreas cancer, and painful bone metastases of the spine and pelvis, the service is fully covered without limitations. In cases of soft tissue sarcoma and local tumor recurrence with compression symptoms in palliative situations, the service will remain in evaluation (Coverage with Evidence Development) until June 30, 2023;
  • The service “Liposuction for the treatment of pain associated with lipedema” is now introduced in Annex 1 of KLV/OPre and will be evaluated (Coverage with Evidence Development) until December 31, 2025. The service will be covered only in case of insufficient response to pain and functional limitations associated with lymphedema last at least 12 months. The service “Lymphovenous anastomosis and transplantation of vascularized lymph nodes for the treatment of lymphedema” is now also introduced in Annex 1 of KLV/OPre and will be in evaluation (Coverage with Evidence Development) until December 31, 2026. The service will be covered only in case insufficient response to pain and functional limitations associated with lymphedema last at least 12 months.

On July 1, 2021, a number of updates in the List of Medical Aids (MiGel/EMAp) were implemented. They mostly concern the amendments in the conditions and limitations for reimbursement of a number of medical aids, mainly aids for aspiration, aids for walking, and ocular prostheses. All the changes and Lists of Medical Aids can be found here.

The List of Analyses (Annex 3), and all the changes, can be found here. Some examples of the updates introduced in July 2021 are listed below:

  • Changes in the conditions for performing (sample type) of 40 various IVD tests;
  • Changes in the limitations for billing of 94 microbiology IVD tests;
  • One new test was added: 6605.64 - Molecular genotyping of human leucocyte antigen (HLA), locus A, B, C, DRB1, DRB3 / 4/5, DQA1, DQB1, DPA1, and DPB1, with the tariff of CHF 134.

This news is just one of about 300 market access news collected by our team in the subscription services “HTA Alerts” and “Reimbursement Alerts” every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news).

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