Press statement | 07.07.2023

Recommendation in case initiated ex officio concerning violation of health insurance-related rights

IHROBiH opened a case ex officio based on a newspaper article published in Nezavisne novine on 5 May 2023 under the headline “I am not someone who complains about pain but it hurts a lot”, pursuant to its mandate and powers.

The said newspaper article refers to the case of treatment of Ms D.K., which the public in the Republika Srpska has been focused on in the last days.

As it turns out from its content, the patient suffers from a rare type of condition that a total of five patients in the whole world suffer from. Following the received chemotherapies, the patient’s tumour did not shrink as there were no effects. One of the healthcare clinics prescribed the treatment with the “smart” drug, which would attempt to keep her disease under control, costs around BAM 6,700 on a monthly basis. It is interesting that the said drug is on the reimbursement list of drugs funded by the Republika Srpska Health Insurance Fund for treating patients suffering from kidney cancer, while it is not on the list for her specific type of condition and she is in the position to fund it herself.

Following the investigation procedure, IHROBiH issued Recommendation no P-156/23 on 1 June 2023, instructing the RS Health Insurance Fund’s Board of Directors as follows:

1. Immediately upon receiving the Recommendation and taking into account the specific nature and all circumstances pertaining to the case, to find a way to put the given drug back on the reimbursement list of drugs funded via the Drug Programme, which would enable the patient to exercise the right to healthcare in keeping with the law
2. When taking the decision, to take into account the IHROBiH finding and ruling as provided in this Recommendation
3. To inform IHROBiH of the actions taken to implement the Recommendation within 30 days from the day it is received.

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