1.WHAT IS THE HEALTH IMPLEMENTATION COMMUNIQUÉ?

 

The Health Implementation Communiqué (“SUT”) is a piece of legislation that contains all details regarding healthcare practices. The purpose of the communiqué is defined as follows:

 

“The purpose of this communiqué is to set out the principles and procedures for benefiting from health services, transportation, daily allowances, and companion expenses financed by the Social Security Institution (hereinafter referred to as ‘the Institution’) in order to ensure that individuals covered by this communiqué maintain their health, regain their health when ill, and benefit from medically necessary health services resulting from occupational accidents, occupational diseases, illnesses, and maternity, and to notify the amounts to be paid by the Institution as determined by the Health Services Pricing Commission.”

 

The annexes to the Health Implementation Communiqué issued by the Social Security Institution (SGK) include detailed regulations on the relevant subjects. One of these annexes, titled “List of Reimbursable Drugs – 4/A,” contains regulations regarding drugs used in cancer treatments that are eligible for reimbursement.

 

2.WHICH CANCER DRUGS ARE COVERED BY SGK?

 

The list of reimbursable drugs is published annually as the “List of Reimbursable Drugs – 4/A” based on the provisions of the SUT. It is subject to periodic revisions.

Notably, immunotherapy drugs such as Keytruda, Opdivo, Enhertu, and Tecentriq were not included in the reimbursement list until the publication of the new communiqué in the Official Gazette dated July 10, 2025, resulting in numerous lawsuits concerning these drugs.

However, with the newly published communiqué, certain changes have been made, and some of these drugs have now been included in the reimbursement scope.

 

3.WHAT SHOULD BE DONE IF THE PATIENT’S DRUG IS NOT COVERED?

 

The absence of a drug from the SUT list does not automatically mean that the Institution will not cover it under any circumstances. However, in such cases, reimbursement requires a judicial process.

 

The principle of the social state requires the government to ensure a minimum standard of living consistent with human dignity. The state must assist citizens in overcoming risks such as illness, old age, and unemployment.

In this context, the Constitution safeguards the right to health and social security (Articles 2, 56, and 60) and imposes a positive obligation on the state to act.

Similarly, Article 17 of the Constitution protects the material and moral existence of individuals, while Article 2 of the European Convention on Human Rights (ECHR) enshrines the right to life.

International instruments such as the Universal Declaration of Human Rights and the International Covenant on Civil and Political Rights also guarantee this right.

 

Accordingly, evaluations must be made not only in line with the communiqué and its annexes but also considering the state’s positive obligation to protect the right to life.

 

Therefore, even if the drug is not included in the list, it is possible to:

 

Apply to the Social Security Institution (SGK); and If rejected, file a lawsuit against SGK with a request for an interim injunction. If the court grants the injunction, the cost of the drug may be covered throughout the treatment period.

 

3.1. APPLICATION TO THE SOCIAL SECURITY INSTITUTION (SGK)

 

Before filing a lawsuit, patients must apply to SGK requesting reimbursement for the paid or payable drug costs. If the application is rejected, a lawsuit may then be filed.

This application is a mandatory prerequisite for litigation.

 

3.2. FILING A LAWSUIT AGAINST THE SOCIAL SECURITY INSTITUTION

 

Because the cost of cancer drugs is often extremely high, and many are not reimbursed by SGK, patients frequently file lawsuits requesting reimbursement.

In these cases, due to the urgency and importance of access to medication for the right to life, plaintiffs often seek interim injunctions compelling SGK to cover the cost during litigation.

 

When deciding whether to grant an injunction, courts assess each case individually, considering: whether the drug is vital to the patient’s survival, whether failure to use the drug would pose a life-threatening risk, and whether denial of treatment could cause irreversible harm.

 

Adana Regional Court of Appeal, 7th Civil Chamber, E. 2020/3008, K. 2020/1677, 05.11.2020:

 

The court ruled that since the plaintiff was a cancer patient with a valid treatment report, and the expert physician confirmed that failure to provide the drug would endanger the continuation of the treatment, the conditions for an interim injunction were met. The defendant Institution’s appeal was therefore dismissed.

 

Thus, even if a drug is not on the SUT list, patients may gain access to it through a lawsuit and an interim injunction.

 

3.3. WHICH COURT HAS JURISDICTION OVER SUCH CASES?

 

According to Article 101 of the Social Insurance and General Health Insurance Law No. 5510,

 

“Unless otherwise provided in this Law, disputes arising from the implementation of this Law shall be heard before labor courts.”

 

Therefore, unless otherwise stated, labor courts have jurisdiction over disputes concerning the application of Law No. 5510.

The competent court is the court located where the SGK branch that issued the contested decision is situated.

 

3.4. WHAT HAPPENS IF THE PATIENT DIES DURING THE LAWSUIT?

 

If the patient dies while the case is ongoing, the heirs must be included in the proceedings to ensure proper party constitution.

 

Failure to do so—especially when no renunciation of inheritance exists and the drugs were used—creates a procedurally flawed situation.

In such cases, the court must rule on the amounts already paid for drugs used prior to the patient’s death.

 

The death of a plaintiff in lawsuits concerning reimbursement of drug costs is unfortunately common.

Failure to include the heirs in such cases constitutes grounds for reversal.

 

Court of Cassation, 10th Civil Chamber, 2022/4271 E., 2022/9310 K.:

 

The Court ruled that where the plaintiff (a lung cancer patient) died during the proceedings, the first instance court erred by declaring the case moot without including the heirs, despite their legal interest. The case should have continued with the heirs duly joined as parties.

 

4.WHAT CHANGES WERE INTRODUCED BY THE HEALTH IMPLEMENTATION COMMUNIQUÉ PUBLISHED IN THE OFFICIAL GAZETTE NO. 32952 DATED JULY 10, 2025?

 

As mentioned earlier, Keytruda, Opdivo, Enhertu, and Tecentriq were not covered by SGK before July 10, 2025, and lawsuits had been filed accordingly.

However, under the new SUT published on July 10, 2025, these key immunotherapies are now reimbursable under specific indications.

 

For pending lawsuits, this new communiqué will have a significant impact, and courts are expected to render judgments in line with the updated SUT provisions.

 

5.CONCLUSION

 

In conclusion, lawsuits concerning the reimbursement of cancer drugs not covered by SGK often involve complex procedures. Courts may fail to adequately examine whether the drug is essential to treatment or to properly address procedural issues, such as including heirs after the patient’s death. As a result, consistent case law has not yet been established, and many judgments are overturned due to incomplete examination.Therefore, it is crucial that such proceedings be handled by a qualified attorney, and that courts conduct thorough and detailed reviews considering the unique nature of these cases.

 

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