Appellant’s refusal to provide coverage for the drug required by Appellant constitutes an arbitrary and illegal action.
On January 20, the Third Chamber of the Supreme Court affirmed the appellate decision issued by the Santiago Court of Appeals in Case No. 139.883-2022, which accepted the security action filed against the National Health Fund, for which the financing for the drug Tricafta To provide treatment for cystic fibrosis suffered by the covered person with due observance of the conditions and limits established in the concerned health plan.
Before the Court of Appeal of Santiago, a security action was filed against the National Health Fund for its arbitrary and illegal act of refusing to finance Trikafta, a drug needed to treat cystic fibrosis. The protected person, despite the existence of a medical indication, violates the constitutional guarantees enshrined in Article 19 No. 1 of the Political Constitution of the Republic, as argued by the appellant.
The Court of Appeal of Santiago, according to information provided in the process, indicated that the denial of coverage for the drug that the appellant needed was an arbitrary and illegal action that violated the guarantee of the right to life Is. …and to the physical integrity of the appellant, as it deprives him of access to it, thereby causing him grave harm and as to the norms regulating health contracts, whether legal or administrative, as such is to be interpreted and applied as a way of maximizing the full and complete exercise of the rights inherent to the human person, in addition to the protection of health guaranteed in Article 19 No. 9 of the Political Constitution of the Republic, rights that are enjoyed by all must be respected and certainly forms the basis of any convention or agreement between the parties.
With regard to the Appellant’s contention that the drug Trikafta does not have a health registration by the Institute of Public Health (ISP), it is arbitrary and inadequate to deny the coverage requested by the Appellant, taking into account that it has been authorized Is. United States. Jointly approved by the FDA for patients who are prone to this disease, such as minors in cars.
After appealing against the sentence given by the Court of Appeal of Santiago, the Supreme Court confirmed the said sentence. However, it agreed with the vote against Mr Mateusz, who was about to overturn the appealed decision.
Supreme Court Roll Number 139.883-2022
Court of Appeal of Santiago Roll No. 1.119-2022