Although there is still no definitive and final solution for the treatment of cancer, which is one of the most common diseases, many different methods are used in its treatment. The most effective treatment approaches are immunotherapy and targeted smart drug therapies.
Immunotherapy stands out as a treatment method that combats cancer cells by activating or suppressing the immune system. Smart drug therapy, on the other hand, is a method aimed at targeting abnormal functions in cancer cells and stopping these functions. These treatment options are applied to strengthen the immune system and extend the lifespan of advanced-stage cancer patients for whom chemotherapy and radiotherapy have not been effective.
Why Doesn’t SGK Cover Cancer Medications?
The Social Security Institution (SGK) covers the costs of medications listed in the Healthcare Implementation Communiqué (SUT) and the List of Reimbursable Medications published on SGK’s official website. However, the coverage of these medications may be subject to conditions such as their use only for the treatment of specific types of cancer or the requirement that the patient has undergone certain prior treatment processes. Therefore, the inclusion of a drug in this list does not automatically mean that its cost will be covered by SGK.
For example, some medications used in immunotherapy and targeted smart drug treatments are not covered by SGK.
- Altuzan
- Opdivo
- Keytruda
- Tecentriq
- Herceptin
- Mabthera
The cost of these medications may vary depending on the duration of treatment and the progression of the disease, and it is not possible to determine in advance how many treatment cycles a patient will undergo. The high cost of immunotherapy and targeted smart drug treatments poses a significant challenge for patients and their families who are financially disadvantaged. If access to these medications is not provided, patients may experience serious disruptions in their treatment process.
What Can Be Done If SGK Does Not Cover Cancer Medications?
It is possible to apply to SGK or take legal action to obtain these medications, which have no alternatives and are critically important for the patient’s survival, and to ensure that their costs are covered by SGK.
How to Apply to SGK?
The application process to SGK is a legal prerequisite for filing a lawsuit. Before initiating legal action for the coverage of the medication, it is mandatory to first apply to the institution. SGK evaluates the request, and if it approves the coverage, the patient can start using the medication without any cost. However, if SGK rejects the request, legal action can be taken. It is crucial to ensure that all necessary documents are fully prepared and submitted to the institution during the application process.
What Can Be Done If SGK Rejects the Request for Medication Coverage?
If SGK rejects the request, a lawsuit can be filed in civil courts. To prevent further harm to the patient, a request for an injunction should be made to the court. Through the injunction request, the medication will be provided free of charge throughout the legal process. In this request for an injunction, the patient’s condition must be detailed in the petition.
Can a lawsuit be filed for medications that have been paid for?
The patient can file a lawsuit even after paying for the medication themselves. In this case, the patient requests the reimbursement of the medication costs from the court. Although reimbursement is often delayed depending on the institution, a court decision opens the way for the patient to receive the reimbursement.
Does the Competent Court Change According to SGK Registration?
In lawsuits regarding the coverage of medication expenses filed against SGK, the competent court depends on the social security institution to which the patient is affiliated. For patients who are affiliated with SGK and Bağ-Kur, the competent court for lawsuits against SGK is labor courts. If labor courts are unavailable, the case is filed in civil courts with the status of labor courts.
For public employees affiliated with the Retirement Fund, the competent court for lawsuits against SGK is administrative courts. In lawsuits filed by employees or retirees under the 4/c scope, it has been determined that administrative jurisdiction is competent, as established by the decisions of the dispute courts.
What Stages Are Involved in the Lawsuit Process?
After the lawsuit is filed, the court initially sends the patient’s file for detailed examination by the Expert Panel. The Expert Panel reviews all of the patient’s records and examines whether the treatment is necessary, considering all the details. If the court deems the report prepared by the Expert Panel sufficient, it will issue a decision in accordance with the findings in the report.
How Long Does It Take for the Case to Be Concluded?
The conclusion of the case depends on the duration of the expert committee’s review. In some places, the review may take longer due to the workload of the expert committees. However, as mentioned above, if a precautionary decision is made, the medication will begin to be covered by SGK during the litigation process.
Since the litigation process and follow-up are intensive and important, patients undergoing treatment may face difficulties in tracking the case. Therefore, it is advised to proceed with the process with the assistance of a lawyer.
Lawyer. Duygu OKUNAKOL & Lawyer Gökhan AKGÜL
Views: 2
