health insurance covered medicines

Swiss Health Insurance: Covered Medicines

Which medicines are covered by Swiss health insurance providers through compulsory and supplementary policies? How high are the benefits? This moneyland.ch guide explains.

Many (but nowhere near all) medicines are covered by Swiss compulsory health insurance. Medicines which do not qualify for this basic coverage can be covered by a supplementary outpatient insurance policy.

Medicines: What does your compulsory policy cover?

  • Obligatory, basic Swiss health insurance covers the cost of medicines if they are prescribed by a doctor or hospital and are included in the official List of Pharmaceutical Specialties.
     
  • The List of Pharmaceutical Specialties lists the medicines which insurance companies are required to cover, and can be found on the website of the Swiss Federal Office of Public Health (bag.admin.ch). You can also find out if a medicine is included on this list by asking your doctor or pharmacist.
     
  • Your health insurance will only cover remaining costs after discounting your annual deductible.
     
  • Additionally, medicines are subject to a coinsurance of 10 percent, which you must pay out of your own pocket. If a generic copy of a brand-name medicine exists, and the generic medicine is at least 20 percent cheaper than the brand-name medicine, you will pay 20 percent of the cost out-of-pocket if you choose the brand-name medicine.
     
  • Play it safe and ask the doctor what a medicine costs at the time they prescribe it. The doctor should, when possible, prescribe the generic make rather than the more expensive original.

Medicines: What do supplementary health insurance policies cover?

  • Medicines which are not covered by compulsory health insurance will have to be paid out of your own pocket, unless you have supplementary health insurance. The right optional insurance coverage, in this case, is included in outpatient insurance policies (also called ambulant insurance).
     
  • Even supplementary health insurance does not cover the costs of all medicines. Each insurance provider has its own list of covered medicines. The supplemental health insurance from most Swiss insurers only covers medicines which are listed by the Swiss Institute for Therapeutic Products (swissmedic.ch). Insurers also have “negative lists” of all the medicines which they deliberately do not cover. Medicines included on negative lists might include lifestyle products, appetite suppressants, diet medication and anti-hair-loss treatments.
     
  • If you are unsure whether the medicines you need are covered, consult your insurance provider’s list of covered and uncovered medicines, or ask your insurer or doctor.
     
  • As with compulsory health insurance, all medicines must be prescribed by a doctor in order to be eligible for coverage.
     
  • Compare the benefits and premiums of different insurance providers – you may find major differences between insurance policies. Because supplementary healthcare coverage comes as a package deal with many different benefits, it is important to look at the overall benefits a policy offers. Getting coverage for alternative medicines normally requires taking out a special supplementary insurance policy.
     
  • The outpatient health insurance comparison on moneyland.ch lets you filter and sort policies based on the benefits which they provide. Use the “medicines” criteria to find the policies which provide good medicine coverage.
     
  • Make sure to compare the actual amounts of compensation you receive for medicine purchases using the moneyland.ch comparison. There are huge differences in the benefits provided by different supplemental insurance policies!
     
  • As with compulsory insurance, a 10 percent coinsurance payment typically applies to purchases of medicines covered by supplemental health insurance policies. That means you have to pay 10 percent of the cost out of your own pocket. 90 percent of the costs of (Swissmedic certified) medicines are covered by your supplemental insurance provider.
     
  • If getting your medicine purchases covered is important to you, opt for policies that are generous in their medicine coverage. Supplemental insurance policies that cover 90% of the costs of medicines include: Helsana Top, Helsana Completa, KPT “Krankenpflege” policies, CSS Outpatient Insurance, Sanitas supplementary insurance, Atupri supplementary insurance policies, Visana supplementary insurance policies, Sanagate supplementary insurance policies.
     
  • Important: Some supplementary insurance policies require higher coinsurance payments of up to 50 percent for medicine purchases (example: Concordia Diversa).
     
  • Other things to look out for when choosing supplementary health insurance are deductibles (same as compulsory insurance) and the maximum amount of coverage provided for medicine purchases. Both Groupe Mutuel Bonus and Swica Completa Top, for example, only cover medicine purchases up to a fixed cap. Some policies, like the EGK Sun 3, place an annual limit on the coverage you can receive.

The moneyland.ch team

More on this topic:
Swiss health insurance comparison
Supplementary outpatient insurance comparison
Hospital insurance comparison
More about Swiss health insurance

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