SL Radar August 2025

In August 2025, the broad tightening of limitations in oncology and related budget drivers is striking. Particularly relevant: more precise cost approval requirements, often with a consultation with a medical examiner, as well as clearer guidelines on the maximum duration of treatment (time caps). Bevacizumab biosimilars (Oyavas/Mvasi/Bevacizumab-Teva) and immunotherapies such as Opdivo/Bavencio affect large patient segments and therefore have an impact on the budget.

• Bevacizumab - Limitation changed: Mandatory cost approval; medical examiner; max. treatment duration - high budget impact
• Opdivo limitation changed: Cost approval; combination in OSCC; time limit until 31.01.2028; max. duration
• Bavencio - Limitation changed: Cost approval; weight limit; max. treatment duration - Check combination paths
• Phesgo - Limitation changed: only in combination according to FI; max. duration; medical officer - follow budget control
• Lonsurf - Limitation changed: Cost credit agreement specified; response criterion; combination specified - Update paths
• Hemlibra - Limitation changed: Cost approval clarified; weight limit - adjust hemophilia flows
• Elrexfio - Limitation changed: Limitation until 31.01.2026; medical examiner - check individual case consultation setup

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Takeways:

Time caps are widely applied; map cap deadlines per indication in approval and budget flows (incl. extension logic). Update authorization templates and checklists with clear mandatory content (prescriber, monitoring, medical officer consultation). Adapt combination and maintenance pathway logics in clinical sequence guides to avoid double reimbursement. Check comparators at ATC level (L01/L04 and relevantB02/A10 segments) and simulate cap impact on volume/budget.

The full report can be requested here: boller@wvlaw.ch.