SL Radar September 2025

September saw a clear shift toward more formalized pricing models and cost approval processes. In oncology, time limits are being extended broadly until 2028 and economic parameters are being tightened (e.g., fixed reimbursement on FAP). In immunology/gastroenterology, precise induction/maintenance regimens and prescriber restrictions are being added; in some cases, further treatment is explicitly linked to cost approval after one year.

SL radar (60 sec.)

• Tecentriq (L01FF05) – Limitation changed: Refund 21.4% FAP; Progression/toxicity specified; Time limit until September 30, 2028 – high budget impact (time)
• Darzalex SC (L01FC01) – Limitation changed: uniform billing price; combination with carfilzomib+dexamethasone; CD38-refractory excluded; until October 31, 2028 – high impact (indication/time)
• Skyrizi (L04AC18) – Limitation changed: Induction 1200 mg W0/4/8; Maintenance 180/360 mg q8w; Continued treatment after 1 year only with cost approval; Prescriber Gastroenterology – high impact (time/KGS)
• Kyprolis (L01XG02) – Limitation changed: Cost approval required; price model with refund; codes 20481.06/20481.04; until October 31, 2028 – high impact (KGS/price)
• Hemlibra (B02BX06) – Limitation changed: one-time cost approval before start; refund mechanism; until December 31, 2028 – high impact (KGS/time)
• Jardiance (A10BK03) – Limitation changed: max. daily dose 10 mg; T2D application logic specified – noticeable impact (volume/dose cap)

In focus

Tecentriq: Fixed refund of 21.4% FAP established as real net; discontinuation logic specified (clinically stable until confirmation of progression/untreatable toxicity). Limited until September 30, 2028; cycle cap (max. 16 cycles) unchanged.

Darzalex SC: Uniform billing price plus price model refund; combination with carfilzomib+dexamethasone specified; exclusion of refractory/relapsed cases under CD38; limited until October 31, 2028.

Skyrizi: GI requirements now strict: induction 1200 mg W0/4/8, maintenance q8w 180/360 mg, continued treatment after 1 year only with cost approval; prescriber gastroenterology

Full report for September 2025: We will be happy to send you the full report with all adjustments for September 2025 upon request.