Unlike many other targeted drugs on this list, Prexet (pemetrexed disodium) is a chemotherapy drug listed on SGK's Reimbursable Drugs List (Annex 4/A) and, within its approved indications, is covered by SGK as a general rule. For this reason, legal disputes concerning Prexet do not arise from the drug being "never covered," but from a health board report not being properly prepared, the drug being prescribed outside the combination/treatment-line conditions required by SUT, or SGK refusing a specific request (such as an additional cycle, dose increase, or a different treatment line).
What Is Prexet (Pemetrexed Disodium)?
Pemetrexed is an antimetabolite chemotherapy drug that works by blocking the folate metabolism required for cell division. Prexet is a generic formulation of this active substance. Its main uses are:
- Malignant pleural mesothelioma (cancer of the lung lining), combined with cisplatin
- Non-squamous non-small cell lung cancer (NSCLC), combined with platinum-based chemotherapy as first-line treatment, or alone as maintenance therapy
Does SGK Generally Cover Prexet?
Yes. Products containing pemetrexed (including Prexet) are paid for by SGK when the indication and combination conditions defined in the relevant provisions of SUT are met. In practice, the exception to this general rule arises from refusals or delays in the following situations:
- The health board report is incomplete or does not contain the details required by SUT (such as histological type, stage, or performance score),
- The drug is prescribed outside the combination or treatment line defined in SUT (for example, together with a drug not foreseen, or at a different treatment line),
- A different frequency or duration of administration than foreseen is requested for maintenance treatment,
- There is a discrepancy between the prescribed dose and the dose-calculation criteria used as a basis in SUT.
In such cases, SGK may partially or fully refuse payment, or effectively cause a delay by prolonging the review process.
Prexet 2026 Price
Based on current data, a 100 mg vial of Prexet costs approximately 6,750 TL, and a 500 mg vial approximately 33,250 TL. Since dosing is calculated based on the patient's body surface area, the total cost of a cycle varies with the vial combination used. When used in accordance with SUT conditions, this cost is, in principle, covered by SGK.
Route to Follow When SGK Refuses or Delays Payment
If Prexet is prescribed within an approved indication and in accordance with SUT conditions yet SGK refuses payment, this act is unlawful and can be directly challenged in court by seeking annulment of the administrative decision. The process generally works as follows:
- [Reviewing the report](/en/ictihat/kanser-ilaci-odeme-olcutleri) and renewing it if necessary: If the refusal generally stems from the report lacking the details required by SUT (histology, performance score, treatment line), it is advisable to first reapply with a complete health board report.
- Written objection/application to SGK: A written objection to the refusal is filed with the Provincial Directorate of SGK, accompanied by the report, pathology results, and treatment history.
- Filing a case if the administrative application is refused: Depending on the patient's insurance status, a case is filed before the labour court or administrative court, seeking annulment of the refusal and coverage of the drug cost.
- Request for an interim injunction: Because the treatment requires continuity, an interim injunction may be sought so that the drug is supplied without interruption while the case is pending.
- Expert examination: The court has experts assess whether the prescribed treatment complies with SUT's criteria and medical necessity.
If the dispute is based on a mode of use not defined in SUT at all (genuine off-label use), an application to TİTCK for off-label use approval is additionally added to the process.
Required Documents
| Document | Description |
|---|---|
| Health board report | Must include histological type, stage, performance score, and treatment line |
| Pathology and discharge reports | Proof of diagnosis and treatment history |
| SGK refusal/objection correspondence | Proof of the pre-litigation application required for the case |
| TİTCK application (if any) | Required if genuine off-label use is involved |
| Invoices | Basis for a reimbursement claim if the drug cost was paid out of pocket |
Duration of Proceedings
Cases based on an unjustified refusal of a right covered by SUT can conclude relatively quickly, as the matter is technically more limited, while files genuinely alleging off-label use can take 6 to 18 months due to the expert examination process.
Frequently Asked Questions
Does SGK generally cover Prexet?
Yes, products containing pemetrexed are, as a general rule, covered by SGK within the indications defined in SUT (mesothelioma, non-squamous NSCLC).
Why would SGK refuse payment for a drug it otherwise covers?
The refusal is usually because the health board report lacks the details required by SUT, or because the prescription falls outside the defined combination/treatment line.
What should I do if the report is incomplete?
Reapplying with a new health board report that fully includes the criteria required by SUT (histology, stage, performance score) can resolve the issue without litigation.
Which court hears a case against SGK's refusal?
A case is filed before the labour court or the administrative court, depending on the patient's insurance status.
Do I have to interrupt treatment while the case is ongoing?
No; a court-ordered interim injunction allows uninterrupted supply of the drug to continue while the case is pending.
Frequently Searched Questions
How Should a Petition for a Prexet SGK Application Be Prepared?
The petition should include a health board report stating the histological type, stage, and performance score, pathology and discharge reports, the refusal/objection correspondence with SGK, and, if genuine off-label use is involved, the TİTCK application.
Where Is the Cost of Prexet Obtained From?
Since Prexet is listed in SUT's Annex 4/A, it is supplied directly through hospital pharmacies under SGK's protocol when prescribed within the approved indication and supported by a complete report. In cases of refusal or delay, the drug may need to be purchased out of pocket from a private pharmacy during the objection/litigation process.
Can the Amount Paid for Prexet Be Reclaimed?
Yes. Prexet costs paid out of pocket due to an incomplete report or an unlawful refusal can be reclaimed through litigation supported by invoices; the claim is subject to the 5-year limitation period under Article 97 of Law No. 5510.
Why Does SGK Refuse Prexet Requests?
The most common grounds are a health board report that omits details required by SUT such as histological type, stage, or performance score; a prescription outside the defined combination or treatment line; and a request for a different frequency or dose during maintenance treatment than what is foreseen.
Which Court Hears a Prexet Case?
Insured persons under SSK or Bağ-Kur file their case before the labour court, while civil servants and retired civil servants within the scope of Article 4/c of Law No. 5510 file before the administrative court.
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