Reader question: Do I have to pay for prescription drugs in Switzerland?
Generally speaking, medications prescribed by a doctor are covered by healthcare insurance. But this doesn’t mean you won’t have to pay any costs at all.
As is the case everywhere else, there are two types of medicines in Switzerland: those you buy without a prescription (over-the-counter — OTC) and those who are by doctor’s orders only.
As a general rule, compulsory health insurance (KVG in German and LaMal in French and Italian) reimburses medicines prescribed by a doctor, as long as they are included on the list of drugs officially approved by Switzerland’s regulatory body, Swissmedic — in total, about 2,500 medications.
The list is quite extensive, comprising not only brand-name and generic meds but also many biosimilars — medicines that are almost an identical copy of an original product manufactured by a different company.
Also covered are some alternative-medicine drugs, including homeopathy and physiotherapy.
What happens when a doctor prescribes a drug that is not authorised in Switzerland?
In principle, the compulsory health insurance will not cover the costs and you will have to pay for it yourself.
However, there are exceptions to this rule.
For instance, even if a particular medication is not approved in Switzerland, but is imported from a country where it is authorised by a body that is considered equivalent to Swissmedic (for example, the European Medicines Agency), then KVG / LaMal will pay for it.
Also, if the cost of a drug is not covered by the compulsory health insurance, and you have taken out a complementary policy, it is possible the latter will pay for it.
These insurance providers have their own lists of medicines which they cover, though certain conditions and limitations may apply.
In general, neither basic nor supplementary insurance will pay for so-called Pharmaceuticals for Special Application (LPPA). This list mainly includes “comfort” products, for example appetite suppressants or products that reduce hair loss.
READ ALSO: Should you buy supplemental health insurance in Switzerland?
How much of the cost does insurance pay?
As is the case for medical treatments in general, KVG / LaMal will pay 90 percent of the cost of medication for which no generics exist.
If, however, an equivalent generic drug is available, but you still choose the brand medicine, then your insurance carrier will cover 80 percent of the price. This means that you will have to pay either 10 or 20 percent of the cost yourself.
This will happen until you use up our entire deductible (franchise), in addition to your 10-percent share of the costs that exceed the deductible — a maximum of 700 francs per year for adults and 350 francs for children.
If you have a low deductible (300 francs), this means that once you use up 1,000 francs toward your medical costs (doctor’s visits, treatments, and medicines combined), you will then not have to pay anything toward your prescription drugs.
By the same token, if you have chosen the highest franchise — 2,500 francs — and add to it the 700-franc co-pay, you may never get to the point where all your medications will be completely covered by the insurance.
READ ALSO: Which Swiss health insurance deductible makes most sense?
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As is the case everywhere else, there are two types of medicines in Switzerland: those you buy without a prescription (over-the-counter — OTC) and those who are by doctor’s orders only.
As a general rule, compulsory health insurance (KVG in German and LaMal in French and Italian) reimburses medicines prescribed by a doctor, as long as they are included on the list of drugs officially approved by Switzerland’s regulatory body, Swissmedic — in total, about 2,500 medications.
The list is quite extensive, comprising not only brand-name and generic meds but also many biosimilars — medicines that are almost an identical copy of an original product manufactured by a different company.
Also covered are some alternative-medicine drugs, including homeopathy and physiotherapy.
What happens when a doctor prescribes a drug that is not authorised in Switzerland?
In principle, the compulsory health insurance will not cover the costs and you will have to pay for it yourself.
However, there are exceptions to this rule.
For instance, even if a particular medication is not approved in Switzerland, but is imported from a country where it is authorised by a body that is considered equivalent to Swissmedic (for example, the European Medicines Agency), then KVG / LaMal will pay for it.
Also, if the cost of a drug is not covered by the compulsory health insurance, and you have taken out a complementary policy, it is possible the latter will pay for it.
These insurance providers have their own lists of medicines which they cover, though certain conditions and limitations may apply.
In general, neither basic nor supplementary insurance will pay for so-called Pharmaceuticals for Special Application (LPPA). This list mainly includes “comfort” products, for example appetite suppressants or products that reduce hair loss.
READ ALSO: Should you buy supplemental health insurance in Switzerland?
How much of the cost does insurance pay?
As is the case for medical treatments in general, KVG / LaMal will pay 90 percent of the cost of medication for which no generics exist.
If, however, an equivalent generic drug is available, but you still choose the brand medicine, then your insurance carrier will cover 80 percent of the price. This means that you will have to pay either 10 or 20 percent of the cost yourself.
This will happen until you use up our entire deductible (franchise), in addition to your 10-percent share of the costs that exceed the deductible — a maximum of 700 francs per year for adults and 350 francs for children.
If you have a low deductible (300 francs), this means that once you use up 1,000 francs toward your medical costs (doctor’s visits, treatments, and medicines combined), you will then not have to pay anything toward your prescription drugs.
By the same token, if you have chosen the highest franchise — 2,500 francs — and add to it the 700-franc co-pay, you may never get to the point where all your medications will be completely covered by the insurance.
READ ALSO: Which Swiss health insurance deductible makes most sense?
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