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.
- 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.
- 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!
- Almost all outpatient supplementary packages offer medication benefits - many at the 90% level mentioned. But beware: some outpatient insurances pay only a fraction - for example 50% - of the costs.
- There are also health care supplements with deductibles (like basic insurance) and maximum amounts for coverage. This means that with these health insurance companies you will only receive compensation for medication up to the fixed amount - for example 50,000 francs per year.
- The following are among the health insurance companies with supplementary outpatient insurance that covers the costs of medications:
- Assura
- Atupri
- Concordia
- CSS
- Groupe Mutuel
- Helsana
- KPT
- Sanitas
- Swica
- Visana
More on this topic:
Swiss health insurance comparison
Supplementary outpatient insurance comparison
