In 2013, the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) applied for a benefit assessment by the Federal Joint Committee (G-BA) in accordance with Section 137c of the German Social Code, Book V (SGB V). The G-BA suspended the decision in 2016 until 2021 in order to be able to include additional study results.
Now, as a result, as neither a benefit nor the “potential” could be demonstrated in the studies the G-BA then excluded the treatment method from reimbursement. The guideline went into effect on Sept. 6, 2022.
This means that the (in-patient) treatment of coronary vessel stenosis with antibody-coated and drug-eluting stents may no longer be provided at the expense of the statutory health insurance system with immediate effect, even if remuneration is still provided for this via the G-DRG system.
Hospitals will no longer be reimbursed for this service.
We are convinced that this drastic change will affect the entire field of interventional heart procedures and will also influence the evaluation of other innovative procedures in the context of reimbursement decisions - at the G-BA, but also at the InEK.
The HcH team will be happy to provide you with further information - please call us or send us an e-mail.
Further information on the topic of remuneration can be found here.
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