Federal social court Mistelpreparate health insurance funds should pay for palliative use

No reimbursement of mistletoe therapy outside palliative therapy
The active ingredients of mistletoe can have a very positive effect on the treatment of cancer. Therefore, a woman had sued her health insurance on the reimbursement for the adjuvant cancer therapy with the anthroposophic non-prescription drug Iscador M. However, the competent social court dismissed the lawsuit and the Bundessozialgericht was rejected in oral proceedings on 15 December (ref .: B 1 KR 30/15 R) the submitted appeal. "Health insurance companies only have to pay for palliative anthroposophic mistletoe preparations," according to the statement of the Federal Social Court on the decision.

After her health insurance company refused to pay for the anthroposophic non-prescription drug Iscador M, the cancer patient filed a complaint with the competent social court. This, however, decided against the applicant. Even in the revision of the Federal Social Court, the woman has now failed. Although the benefits of mistletoe therapy for cancer are well known, but according to the Federal Social Court remain "pharmacy-based, non-prescription drugs such as the mistletoe preparation Iscador M excluded from the supply of drugs according to SGB V." The cost transfer is limited to use in palliative medicine.

The reimbursement for the use of anthroposophic mistletoe preparations is only intended for palliative use. (Image: PhotoSG / fotolia.com)

No claim to the supply of anthroposophic mistletoe preparations
The assumption of the Joint Federal Committee (GBA) is based on the assumption of costs for the medicines. However, the GBA has included the mistletoe preparations "exclusively limited to use in palliative therapy in the list of prescription non-prescription drugs", reports the Federal Social Court. The plaintiff's appeal was dismissed, according to the court's ruling, and she has no claim to the supply of the non-prescription drug Iscador M for adjuvant cancer treatment. According to the Federal Social Court, the restriction of use "in palliative therapy" also applies to drugs of special therapeutic directions.

Among other things, the Federal Social Court bases its decision on the fact that the GBA has sufficient democratic legitimacy to lay down guidelines for non-prescription medicines in the case of serious illnesses, an exceptional regulation - with the appropriate contractual medical justification - is possible. (Fp)