Significant Turkish Supreme Court Decision on the Reimbursement of Cancer Medicine Costs by the SSI

Over the past several years, numerous lawsuits have been initiated seeking reimbursement for medicines used in the treatment of cancer and rare diseases that are not included within the reimbursement coverage of the Social Security Institution (“SSI”). While many of these medicines provide innovative treatment options, they are also highly expensive. As the SSI frequently refuses to cover the cost of such medicines on the grounds that they are not included within the scope of reimbursement under the Healthcare Implementation Communiqué (“HIC”), patients are often compelled to pursue judicial remedies. The 10th Civil Chamber of the Turkish Supreme Court, which reviews such disputes as the court of final appeal, adopted a restrictive approach in a number of decisions issued particularly in 2024 and 2025. In those decisions, the Chamber held that the cost of a medicine could be reimbursed only where its use was necessary and where it was effective on a continuous basis rather than merely providing short-term benefits. On this basis, the Chamber reversed numerous judgments in which first-instance and regional appellate courts had ruled in favour of patients and ordered the reimbursement of medicine costs.

However, in its recently published decision dated 11 May 2026 and numbered E. 2026/6484, K. 2026/6783, the 10th Civil Chamber significantly softened its previous restrictive approach in the circumstances of the case and unanimously upheld the judgment of the Denizli 6th Labour Court resisting the Chamber’s earlier reversal decision. In the case at hand, the 10th Civil Chamber assessed together the fatal nature of the claimant’s cancer, the prescription of the medicine by a medical oncology specialist, the medicine’s marketing authorisation and approval status in relation to the relevant disease, and its position in the existing medical literature. The decision is significant in terms of the legal criteria applicable to disputes concerning medicines outside the reimbursement coverage and the limits of judicial review.

This newsletter outlines the proceedings leading to the decision, compares the criteria applied in the decision with those adopted by the 10th Civil Chamber in its recent case law, and considers the decision’s potential implications for practice.

Proceedings Leading to the Decision

The dispute arose from the SSI’s refusal to reimburse a medicine containing the active substance nivolumab, used in the treatment of lung cancer, on the grounds that it was not covered by the HIC for the claimant’s condition during the relevant period. The claimant sought the annulment of the SSI’s decision and reimbursement of the medicine expenses already incurred, arguing that the medicine had been prescribed by a specialist physician and was necessary for the treatment. The Denizli 6th Labour Court, acting as the first-instance court, obtained an expert report from the Department of Medical Oncology at Pamukkale University. The report concluded that nivolumab treatment was medically and scientifically appropriate in view of the claimant’s clinical condition and had the potential to increase survival compared with existing treatment options.

Relying on the expert report, the first-instance court upheld the claim. Following the dismissal of the SSI’s regional appellate application, the 10th Civil Chamber of the Supreme Court reviewed the case and reversed the judgment. The Chamber held that a more comprehensive expert panel should determine whether the medicine was medically necessary, of vital importance and continuously more effective than existing treatments. The first-instance court resisted the reversal decision. It held that requiring proof of definite and continuous efficacy was unrealistic in relation to cancer medicines and further noted that the SSI had not raised any specific objection alleging that the medicine was unnecessary or ineffective.

Upon reviewing the resistance judgment, the Supreme Court unanimously upheld it. As a result, it was ordered that the cost of the medicine be covered by the SSI throughout the treatment period and that the previously incurred expense of TRY 54,044.37 be reimbursed together with interest.

Comparison with Previous Supreme Court Decisions

In its decisions issued in 2024 and 2025, the 10th Civil Chamber held that cancer medicines not included within the scope of the HIC could be reimbursed by the SSI only where the medicine was medically and scientifically necessary, of vital importance, continuously effective and beneficial, had completed all phases of clinical trials, was accepted by medical authorities, and was not subject to any acceptable objections or reservations raised by SSI. In this ontext, the Chamber required comprehensive expert reports from university medical oncology departments addressing the type and stage of cancer for which the medicine would be used, the benefit it would provide to the patient, and its superiority over existing treatments.

By contrast, the resistance judgment upheld by the Supreme Court accepted that this restrictive approach should be reconsidered in light of the particular characteristics of cancer treatment. The resistance judgment stated that it is not possible to predict definite and continuous success for every patient in relation to any cancer medicine. It further held that a treatment cannot be regarded as lacking medical benefit merely because it does not completely eliminate the disease, where it nevertheless extends survival or keeps the disease under control. Accordingly, the court found that requiring proof that a medicine would be definitively and continuously effective would make it practically impossible to obtain reimbursement through litigation for many medicines used in cancer treatment. The first-instance court also held that judicial review in this field should not be conducted by substituting the court’s assessment for that of the SSI and carrying out a cost-benefit analysis. Rather, the review should focus on whether the refusal to reimburse the medicine violated the patient’s rights to life and social security in the circumstances of the individual case. Within this framework, the resistance judgment stated that the relevant considerations should not be limited to whether the medicine provides a definitive cure. Instead, the courts should assess whether the medicine is authorised and medically accepted, whether it has been prescribed by a specialist physician, and whether there is a reasonable prospect that it will provide a medical benefit to the patient.

The resistance judgment also noted that claims concerning medicine costs brought by insured persons subject to Law No. 5434 are heard by the administrative courts and that, in such proceedings, the medical efficacy of the medicine is not reassessed. Under this approach, greater weight is given to the responsibility of the treating physician and the patient’s right to life. The court observed that applying different judicial standards to persons subject to different social security regimes could raise concerns in terms of equality and the right to a fair trial. Although administrative court decisions are not binding on civil courts, the resistance judgment emphasised that unjustifiably divergent outcomes should be avoided in relation to comparable healthcare claims.

The resistance judgment further referred to the decision of the General Assembly of Civil Chambers of the Turkish Supreme Court dated 21 May 2014 and numbered E. 2013/10-1282, K. 2014/678, concerning reimbursement for drug-eluting stents. In that decision, the General Assembly held that priority should be given to the physician’s choice and that patients could not be expected to assess the medical correctness of that choice, even though the scientific community had not conclusively established that drug-eluting stents were medically superior to bare-metal stents. In the present case, this approach was applied to a dispute concerning a cancer medicine. The treating physician’s medical judgment was regarded as a central consideration in protecting the patient’s rights to life and health.

Against this background, the decision demonstrates that such disputes cannot be resolved solely by determining whether the medicine is included in the HIC or whether a specific degree of clinical superiority has been conclusively established. Courts must also assess whether the SSI’s decision is compatible with the constitutional rights to life, health and social security, as well as the principle of equality. The decision acknowledges that restrictions on access to healthcare may be introduced to protect public resources. However, it emphasises that such restrictions cannot be applied in a manner that undermines the essence of the right to health, which directly concerns human life.

Conclusion

The decision of the 10th Civil Chamber of the Turkish Supreme Court dated 11 May 2026 strengthens a patient-oriented approach centred on the rights to life and social security in disputes concerning the reimbursement of cancer medicines.

Although the criteria of medical necessity, continuous efficacy and superior effectiveness compared with existing treatments, which featured prominently in previous decisions, have not been entirely abandoned, the current decision accepts that these criteria should not be applied with a degree of rigidity incompatible with the nature of cancer treatment. Accordingly, in the circumstances of the case, it was considered inappropriate to refuse reimbursement solely on the grounds that the medicine was not included within the HIC, where it had been prescribed by a specialist physician, was subject to the necessary administrative approvals and was supported by scientific evidence indicating a potential clinical benefit.

The decision does not mean that the cost of every medicine outside the reimbursement coverage may be recovered from the SSI through litigation. In comparable cases, the patient’s clinical condition, the level of scientific acceptance of the medicine for the relevant indication, available treatment alternatives, the existence of a marketing authorisation or off-label use approval, and the specific objections raised by the SSI will continue to be assessed together. Nevertheless, the decision constitutes a strong precedent insofar as it significantly narrows the scope of application of the previous approach requiring proof of definite and continuous efficacy.

AUTHORS

Nuri Melih İnce

Lara Bayrakdar