{"id":924,"date":"2025-02-10T14:02:09","date_gmt":"2025-02-10T14:02:09","guid":{"rendered":"https:\/\/www.bayraklaw.com\/?post_type=portfolio&p=924"},"modified":"2025-02-11T11:19:00","modified_gmt":"2025-02-11T11:19:00","slug":"sosyal-guvenlik-kurumunun-sgk-karsilamadigi-kanser-ilaclari-icin-hukuki-yollar","status":"publish","type":"portfolio","link":"https:\/\/www.bayraklaw.com\/en\/bultenler\/sosyal-guvenlik-kurumunun-sgk-karsilamadigi-kanser-ilaclari-icin-hukuki-yollar\/","title":{"rendered":"Legal Ways for Cancer Medications Not Covered by the Social Security Institution"},"content":{"rendered":"

During the cancer treatment process, patients and their families face various challenges. Among these challenges, cancer medications not covered by the Social Security Institution (SSI) are at the forefront.<\/span><\/p>\n

The financing of necessary medications for cancer patients is shaped according to the criteria set by SSI. SSI's regulations regarding healthcare services are addressed under the Health Implementation Communiqu\u00e9, which clearly defines which medications are covered by reimbursement.<\/span><\/p>\n

According to Article 4.1.9 \u2013 Medications to be Paid for (APPENDIX-4\/A) of the Health Implementation Communiqu\u00e9, medications to be covered by SSI are listed in the \"List of Medications to be Paid for (APPENDIX-4\/A)\" published on the Institution's official website. As clearly stated in the Communiqu\u00e9, medications that do not have a commercial name and barcode\/QR code number in this list will not be reimbursed by SSI under any circumstances. However, it is noted that special regulations regarding medications obtained from abroad are excluded from this scope.<\/span><\/p>\n

This regulation emphasizes SSI's authority to determine which medications are covered under reimbursement, while also causing significant issues for patients.<\/span><\/p>\n

In particular, the immunotherapy and chemotherapy medications not covered by SSI create a significant financial burden for patients. This situation leads some patients to seek legal avenues to demand that the state covers the cost of the medications. In this article, we will provide detailed information on the legal processes and steps involved in filing a lawsuit to access cancer medications that are not covered by the state.<\/span><\/p>\n

1. Doctor's Application<\/strong><\/span><\/h2>\n

Firstly, your doctor needs to submit an application to the Turkish Medicines and Medical Devices Agency under the Ministry of Health. The application should include convincing statements such as the unavailability of an equivalent medication, the life-threatening nature of the condition, and the necessity of the medication for maintaining the patient's quality of life.<\/span><\/p>\n

2. Written Petition to the Social Security Institution (SSI)<\/strong><\/span><\/h2>\n

For immunotherapy and smart drugs, which are proposed for the treatment of cancer and are not covered by SSI, the patient, the patient's family members, or their representative must first submit a petition to the Health Social Security Center of the SSI Provincial Directorate to request that the medication be covered by SSI and to seek reimbursement for the paid medication costs.<\/span><\/p>\n

At this stage, it is important to express your request in a way that covers the entire treatment process without interruption when applying to SSI. Otherwise, if you wish to expand your request later, you may need to apply again.<\/span><\/p>\n

The application to SSI is a prerequisite for both the Labor Court and the Administrative Court. It is not possible to file a lawsuit regarding cancer medications without completing this procedure. Therefore, to initiate the legal process, an application to the administration must be made first.<\/span><\/p>\n

The written application must include the name of your cancer, information about the hospitals where you have been examined and tested, and the name of the cancer medication you wish to be covered. The petition must be accompanied by documents such as the diagnosis report for the illness, the official certified version of the medication usage report, and the original certified version of the prescription issued by the doctor, including the doctor's stamp and protocol number.<\/span><\/p>\n

Documents That Must Be Included in the Initial Application to SSI:<\/strong><\/span><\/p>\n

    \n
  1. The original certified version of the prescription<\/strong><\/span><\/li>\n
  2. The original certified version of the medication usage report<\/strong><\/span><\/li>\n
  3. The approval for Off-Label Drug Use issued by the Ministry of Health's Medical Devices and Pharmaceuticals Agency, submitted by your doctor<\/strong><\/span>\n