As of January 1: NHIF to Cover Treatment for 3 New Diseases

The Supervisory Board of the National Health Insurance Fund (NHIF) has approved the expansion of the List of Diseases for which medicinal products, medical devices, and dietary foods for special medical purposes are fully or partially reimbursed for home treatment. The changes were adopted at a meeting held on November 21 and will take effect on January 1, 2025.

The expansion is the result of proposals from leading specialists and members of expert councils in the respective medical specialties. The evaluation process utilized statistical data from the NSI regarding causes of mortality and disease structure, as well as information from the NCPHA regarding leading causes of hospitalization and primary disability certification. The objective is to ensure more adequate access to treatment for patients with rare, chronic, and severe diseases.

The list now includes the disease group “Congenital adrenogenital disorders associated with enzyme deficiency,” which covers congenital adrenal hyperplasia and 21-hydroxylase deficiency. These are rare genetic conditions leading to adrenal insufficiency, hormonal imbalance, and the risk of severe, life-threatening crises.

Treatment involves lifelong hormone replacement therapy with hydrocortisone. Precise dosing is particularly critical in children to avoid both metabolic decompensation and iatrogenic Cushing’s syndrome. Since 2019, Alkindi—a granulated hydrocortisone that allows for accurate dosing in pediatric patients—has been available on the European market.

The list also includes the rare hereditary degenerative disease “Friedreich’s Ataxia.” It is caused by mutations leading to reduced production of the mitochondrial protein frataxin and severely affects the nervous system, heart, and pancreas.

Patients develop progressive impairments in coordination and balance, reduced sensitivity, muscle weakness, cardiac complications, diabetes, and spinal and foot deformities. In late stages, dysphagia and an increased risk of aspiration pneumonia occur. The approved therapy for home treatment allows for the slowing of neurological decline and an improvement in quality of life.

The list is also expanding to include severe, treatment-resistant epilepsy syndromes—Lennox-Gastaut (LGS) and Dravet syndrome. These are associated with a poor prognosis, frequent and difficult-to-control seizures, as well as significant impairment of intellectual, cognitive, and behavioral functions.

Also included are a number of diseases related to vascular disorders and complicated wounds, including:

• atherosclerosis of the arteries of the extremities
• embolism and thrombosis of peripheral arteries
• phlebitis and thrombophlebitis of the lower extremities
• varicose veins with ulcers and inflammation
• decubitus ulcers
• ulcers of the lower limbs, not elsewhere classified

These conditions require systematic and long-term treatment with specialized medical devices and dressings to prevent complications that often lead to hospitalization or even amputations.

Among the new diseases is IgA nephropathy (Berger’s disease)—a rare, chronic, and progressive immune-mediated kidney disease. It is one of the leading causes of kidney failure. Diagnosis is established solely through a kidney biopsy.

Since 2022, the first targeted medication for IgA nephropathy intended for home treatment has been approved and will now be covered by the NHIF.

The decision takes effect on January 1, 2025, and reimbursement for the therapies will begin at the start of next year. It is expected that a significant number of patients with rare and chronic diseases will gain better access to innovative and timely treatment in a home setting.