Public price and ex-factory price

What separates the public price from the ex-factory price?

The ex-factory price is the amount the authorisation holder receives for the pack. The public price is the amount invoiced to the patient or the insurer. The gap between them consists of the distribution share, which pays wholesale and the dispensing point, plus value added tax.

Both prices are maximum prices. The FOPH sets them by ruling and publishes them monthly, normally effective on the first day of a month. The cost effectiveness assessment works on the ex-factory price, while the patient's invoice works on the public price.

How is the public price built up?

The cascade has three steps. The distribution share is added to the ex-factory price and consists of a price dependent percentage plus a fixed amount per pack. VAT of 2.6 per cent is then calculated on that sum. The result is rounded and published as the public price.

1. Set the ex-factory price from the foreign price comparison and the therapeutic cross comparison.
2. Apply the percentage element of the distribution share, which falls as the ex-factory price rises.
3. Add the fixed amount per pack, which covers logistics independently of the goods value.
4. Calculate VAT of 2.6 per cent on the sum.
5. Round to 5 centimes and publish the result as the public price in the Specialities List.

The distribution share is governed by Art. 67 of the Health Insurance Ordinance and tiered by dispensing category and price band. It belongs to distribution, not to the authorisation holder, so cutting the ex-factory price never cuts the public price by the same franc amount.

Worked example: a cheap pack and an expensive pack

The figures below are freely chosen and serve only as an illustration; the actual rates follow from Art. 67 of the Health Insurance Ordinance. They show the key point: on a cheap pack the fixed amount makes up most of the distribution share.

The last row clears up a common misreading: the margin on a cheap pack looks high because the fixed amount pays for the act of dispensing and does not scale with the goods value. In francs, distribution still earns more on the expensive pack.

Why may a pharmacy charge less but never more?

Because the public price in the Specialities List is a maximum price. Basic insurance reimburses at most that amount and the dispensing point may not exceed it. Going below it is allowed, for instance through a discount, which lowers the insured person's co-payment accordingly.

• Maximum price character: exceeding it is inadmissible and not reimbursable.
• Charging less is permitted, and discounts must be visible on the invoice.
• Franchise and co-payment are calculated on the amount actually invoiced.
• For private payment outside the reimbursement obligation, the list price does not bind in the same way.

What is the pharmacist's service fee and where does it show?

The pharmacist's service is a separate tariff position and is not part of the public price. It is billed under the performance based remuneration tariff (LOA), for example as a validation check per prescription line and as a patient related flat fee. It appears on the invoice as its own line.

• Medicine price: the Specialities List public price per pack dispensed.
• LOA positions: payment for the pharmaceutical service, independent of the pack's goods value.
• Both are charged to basic insurance and subject to the franchise and the co-payment.
• This split explains why two pharmacies can invoice different totals for the same product price.

How do I read the two prices in an SL entry?

Each entry shows the ex-factory price and the public price per pack, together with pack size, strength and any limitation. For comparing products the clean measure is the ex-factory price per dose; for the patient's invoice the public price is what matters.

• Compare per daily dose rather than per pack, otherwise pack sizes distort the picture.
• Check the as-of date: price changes normally take effect on the first day of a month.
• For flagged originator products, factor in the 40 per cent co-payment.
• The gap between the two prices is not the authorisation holder's profit but distribution and tax.