SGK's notable decision: Drug, treatment, and reimbursement rules have changed

The Turkish Social Security Institution (SGK) has enacted significant changes to its Health Implementation Communiqué (SUT), affecting a wide range of healthcare services, from pharmaceuticals to medical devices and reimbursement policies. These updates, published in the Official Gazette, aim to recalibrate drug prices, redefine reimbursement criteria for treatments like Spinal Muscular Atrophy (SMA), and expand coverage for new medical procedures.

Drug lists and prices have undergone substantial revisions. The EK-4/C drug list saw numerous price updates, with some medications having their barcode and name information altered. Citing cost reasons, certain products were removed and replaced. Notably, the price of MeCasermin, an active ingredient, surged from 62 Euros to 680 Euros. Other drugs like Firdapse 10 mg (amifampridine) were priced at 110 Euros, while products containing Pegaspargase ranged from 600 to 660 Euros. Prices for medications with rufinamid as an active ingredient were updated between 99 and 199 Euros.

Significant adjustments have also been made to the reimbursement and usage principles for nusinersen sodium and risdiplam treatments for SMA patients. The SGK has redefined the criteria for accessing these life-saving therapies, impacting how patients can receive them.

Furthermore, the SGK has incorporated numerous new procedures into its fee-per-service and diagnosis-related group lists. These additions include services such as vaginal birth after cesarean, polysomnography, diagnostic cholangioscopy with biopsy and stone removal, Actinium-225 PSMA therapy, bone density measurement with QCT, bronchoscopic cryobiopsy, and pulsed field ablation, among others. The updated lists also specify the eligible healthcare institutions, procedure points, and reporting requirements for these new services. For instance, Actinium-225 PSMA therapy is assigned 267,750.68 points, while vaginal birth after cesarean is set at 7,582.30 points.

Finally, the regulations concerning home healthcare services have been revised, outlining new provisions for physical therapy and rehabilitation that can be administered at home.