Together for More Accessible Healthcare

Health law is a field that touches every one of us. When it comes to our health, legal regulations and their interpretation become deeply personal. Our firm has long been dedicated to representing patients in proceedings under Section 16 of the Public Health Insurance Act, that is, in cases where it is necessary to apply for exceptional reimbursement of medicinal products or medical devices. In most instances, these involve patients with serious oncological diseases.

Our partner, Klára Dvořáková, has been a specialist in this area for many years now, and thanks to her expertise, we are able to help patients assert their rights even in complex disputes with insurance companies. These cases are not just about legal questions and medical terminology, but above all about people, their stories, and the hope of prolonging a good quality of life. What might such a situation look like? We would like to share with you two examples we have dealt with in recent months. 

First case: A new chance thanks to exceptional reimbursement

We represented a client, a patient with a rare small bowel tumour (GIST), who had exhausted all reimbursed treatment options and whose oncologist recommended the medicine QINLOCK (ripretinib). However, the patient’s insurer rejected the application for reimbursement. Under the leadership of Klára Dvořáková, our firm prepared a detailed appeal in cooperation with the patient’s doctors, explaining why QINLOCK was the only truly effective treatment and why the case was exceptional. In this instance, we succeeded already at the appeal stage in persuading the insurer, which subsequently began covering the patient’s treatment. 

Second case: A patient who began treatment as a self-payer

Another client was a patient who had applied for exceptional reimbursement, but was refused by the insurer and therefore began treatment at his own expense. After some time, however, financial pressures became overwhelming, and he applied for exceptional reimbursement again. The insurer initially refused to consider his request, arguing that the patient could not apply once treatment had already begun. We did not give up and successfully argued in court that the insurer’s approach was mistaken. The fact that the patient was benefiting from the treatment was, according to the court, a relevant argument both for assessing whether it was the only possible treatment and for the exceptionality of the case. The insurer later approved the exceptional reimbursement, giving us a double victory. 

Third case: Clinical studies vs. the treating doctor’s recommendation

We represent several clients diagnosed with an aggressive brain tumour (glioblastoma). For some of these patients, their treating physicians recommend treatment using the TTF (Optune) medical device, which was not reimbursed at all until 1 October 2025 and has since become reimbursable only for a limited group of patients meeting the condition of first occurrence of the tumour and being treated in combination with temozolomide. Many patients still do not meet these criteria, making applications for exceptional reimbursement necessary. Insurers often argued that, particularly in cases of recurrence, the use of TTF (Optune) was more akin to experimental treatment and rejected these applications. When the Municipal Court sided with the insurer, we filed a cassation complaint and were delighted when the Supreme Administrative Court ruled in our favour, stating that decisions cannot be made solely by referencing tables, but must respect the recommendations of treating physicians. The court emphasised the need to consider how the treatment is working for the patient, how well it is tolerated, and what quality of life it provides; not merely survival statistics. If a court has doubts, it should consult medical experts rather than assess technical matters on its own. 

Refusals by insurers can be overturned

Every patient’s story is unique, yet all share the desire for dignified and accessible treatment. We are proud to stand by these patients and help ensure that the law becomes a tool of support rather than an obstacle.

In the case that you are encountering difficulties with your insurer regarding exceptional reimbursement of medicines or other healthcare, please do not hesitate to contact us. Together, we will always strive to use the law to the patient’s benefit.