The Task Force Care Structures and Therapeutics of the Disease-Related Competence Network Multiple Sclerosis (KKNMS e.V.) has commented on the increasing delays in the reimbursement of guideline-compliant therapies for multiple sclerosis by private health insurance companies (PKV). The experts see this as a considerable risk for affected patients.

Multiple sclerosis is a chronic inflammatory disease of the central nervous system that can lead to permanent neurological damage. Modern disease modifying therapies (DMT) make it possible to control disease activity, reduce relapses and slow down the progression of disability. However, the therapeutic benefit depends crucially on an early start of therapy – the so-called “window of opportunity”.

In practice, however, neurologists repeatedly observe delays in the reimbursement of costs by private health insurance companies. Especially in the case of cost-intensive, highly effective therapies, there would be extensive queries, repeated requests for documents or the involvement of external experts. Such test procedures could take several weeks and significantly delay the necessary start of therapy.

The KKNMS points out that these delays are not medically neutral. During administrative examinations, new inflammatory lesions may arise or relapses may occur, leading to permanent neurological deficits. Once axonal damage has occurred, it is irreversible. The experts therefore demand that insurance audits must not delay the start of medically necessary therapies and that insured persons receive prompt clarity about the reimbursement of costs.

Privately insured patients would thus in fact receive worse care than those with statutory health insurance, for whom there are statutory deadlines for benefit decisions. This is contrary to the principle of equivalent medical care, regardless of insurance status. The task force also sees possible liability consequences for insurance companies if delays cause damage to health.

The KKNMS calls on the legislator and the private health insurance company to ensure timely and transparent processing processes so that people with multiple sclerosis have early access to therapy in accordance with guidelines, regardless of their insurance status. Loss of time in MS therapy could lead to severe disabilities in the long term and should not be caused by avoidable administrative processes.

Further information:

Competence Network Multiple Sclerosis –

Read Also:

Researchers discover new biomarkers for multiple sclerosis – MedLabPortal

KKNMS criticizes abuses in ASV multiple sclerosis – MedLabPortal

Editor: X-Press Journalistenbüro GbR

Gender Notice. The personal designations used in this text always refer equally to female, male and diverse persons. Double/triple naming and gendered designations are used for better readability ected.