Argentina Supreme Court overturns Trikafta medication coverage ruling

The Supreme Court of Argentina has overturned a ruling that required the health insurance provider OSDE to provide exclusive coverage for the imported medication Trikafta. The Court determined that the previous decision by the Chamber was arbitrary due to an inadequate assessment of evidence and a failure to consider the applicable legal framework.

The case involves a patient with cystic fibrosis seeking coverage for a triple modulator therapy consisting of elexacaftor, tezacaftor, and ivacaftor. While OSDE offered a national alternative, Trixacar, which is authorized by ANMAT and contains the same active ingredients, lower courts had previously rejected this substitution. The Supreme Court noted that while Law 27.552 guarantees coverage for cystic fibrosis medications, the Executive Branch had vetoed provisions preventing the substitution of medications prescribed by treating physicians. The Court emphasized that regulatory frameworks allow health authorities to define the scope of coverage within the official medication basket.