The SPAP program provides patients with access to selected oncological drugs if they are medically necessary and have been rejected by the health insurance company. It pursues the vision that all patients should have access to medically indicated oncological therapies. As an experienced partner in dealing with medical dossiers, Adjumed Services AG provides the platform for communication and data exchange between the applicant (who represents the patient), the SPAP secretariat and the SGMO expert panel.

Background

People living in Switzerland generally benefit from a high-quality healthcare system. In particular, the individual case assessment in accordance with Article 71a-d of the Ordinance on Health Insurance (KVV) makes it possible to reimburse therapies at an early stage via the compulsory health insurance (OKP), even if they have not yet been approved by the Swiss market authorization authority (Swissmedic) or are on the list of medicines to be reimbursed by the OKP (Federal Office of Public Health).

In a few individual cases, however, patients do not receive reimbursement from their health insurance for treatment they urgently need. These refusals are a great burden for both the patients concerned and the doctors treating them.

The Swiss Patient Access Pilot (“pilot project”), which ran from April 2019 to December 2022, addressed precisely this point and showed how such “hardship cases” in our healthcare system can be addressed. The solution consists of an assessment of the hardship cases by independent medical experts, who then make a binding recommendation for the marketing authorization holders.

The Swiss Patient Access Program (SPAP) is a continuation of the pilot project with a start date of 1.7. 2023 and a planned duration of 3 years under the directive of the Swiss Society of Medical Oncology (SGMO).

SPAP builds on the positive findings of the pilot project and pursues three project objectives:

1. Continue to offer a solution for so-called hardship cases in the oncology setting with the involvement of medical experts (similar to the pilot project).
2. Assessment of patient benefit based on routinely collected health data. To this end, a concept and an implementable model for future quality registers for the collection of suitable parameters for the assessment of patient benefit will be developed within three years using a targeted collection of health data. The assessment criteria (checklist) developed there will be consistently applied within a scalable digital solution environment.
3. Finding a long-term solution to support the problem of hardship cases by making the results of the program available to healthcare stakeholders through publication. The program, like the pilot, is fully funded by the participating pharmaceutical companies.

The SPAP program was launched in 2023 in a collaboration between the Swiss Society of Medical Oncology (SGMO), Bristol-Myers Squibb SA and Roche Pharma (Switzerland) Ltd. and is limited to oncological therapies. The project is being implemented by SICOmed AG (secretariat). It is now open to all other companies to participate. The program is scientifically monitored. The experience gained from this program will be used to conduct a solution-oriented dialogue with all stakeholders involved on how to ensure sustainable access to medically indicated therapies.

The project is technically managed by Adjumed Services. The tried-and-tested and highly functional Adjumed.net platform allows the applicant’s submission, the anonymization by the secretariat, the various opinions by the experts and the communication of their decisions to the applicant to be carried out in a structured, documented process. This enables an overview of the pending cases at any time as well as statistical evaluations for the stakeholders. It goes without saying that data protection and data security are guaranteed at the highest level at all times.