Swiss medicine pricing and reimbursement research

The Specialities List (SL) is the exhaustive list of medicines reimbursed by Swiss mandatory health insurance. The Federal Office of Public Health maintains it under Art. 52 of the Health Insurance Act, sets a maximum price for every pack and publishes changes monthly. It currently holds 3'402 preparations across 10'264 packs.

No. Swissmedic authorises roughly 7,000 medicines, but only the 3'402 SL preparations are reimbursed by basic insurance. If a medicine is not on the SL you pay for it yourself, unless individual case reimbursement under Art. 71a-d of the Health Insurance Ordinance applies.

The ex-factory price is what the authorisation holder receives for the pack. The public price adds the distribution share set by the FOPH (wholesaler and pharmacy) plus 2.6 per cent VAT. Both are maximum prices, so nothing above them may be charged.

A limitation is a reimbursement condition: a narrower indication, a patient group, a dose, a treatment duration, prior therapy or cost approval from the insurer. 1'454 of the 3'402 preparations carry one. Outside the limitation the medicine is authorised but not reimbursed.

The FOPH publishes monthly, normally effective on the first day of a month. In addition it reviews every preparation's admission conditions every three years, recalculating the foreign price comparison and the therapeutic cross comparison.

After Swissmedic authorisation the authorisation holder files an admission request with the FOPH including a foreign price comparison, a therapeutic cross comparison and a turnover forecast. The Federal Drug Commission assesses efficacy, appropriateness and cost effectiveness; the FOPH decides and sets the maximum price.