Savings models like the family doctor, telemedicine and HMO models are becoming increasingly popular thanks to their notable premium-saving potential. Since the 2016 health insurance year, the pharmacy model has given insurance deal hunters something new to talk about.
The pharmacy model is so new in Switzerland that the database released by the Federal Office of Public Health (FOPH) does not yet list it as a unique model. The Priminfo database released by the FOPH still includes just four compulsory health insurance models: standard, HMO, family doctor and telemedicine.
The new pharmacy-based offers provided by Swiss health insurers are currently included under the family doctor or telmed model category. This can lead to misunderstandings.
How does the pharmacy model work?
Unlike the family-doctor model, holders of pharmacy model policies are required to visit eligible pharmacies as a first stop (gatekeeper). Additionally, the choice of eligible doctors for further consultation may be limited to a pre-defined list of doctors (family or HMO doctors).
Pharmacy consultations are carried out in a private consultation room. Minor health problems can generally be solved right at the pharmacy. The pharmacist can also provide you with medicines.
If health problems are more complex, the pharmacist refers you to doctors, specialists or hospitals. Pharmacies often work closely with telemedicine services and healthcare centers (like Medgate and Sante24), and contact these when necessary.
As an alternative to visiting a pharmacy, some health insurance providers also let you contact a hotline – as you would with a telemedicine insurance policy.
As with the family doctor model, you normally will not have to visit a pharmacy as a first stop before visiting eye doctors, gynecologists or pediatricians. In the event of a medical emergency, you can get help from a doctor or hospital immediately without dropping by a pharmacy first. In the case of ongoing treatments, the pharmacy does not need to be consulted in advance ahead of each session.
Pharmacy model policies compared
At this point, pharmacy-model policies offered in Switzerland include the pharmacy models from Swica (and its subsidiary Provita) and Sympany (and its subsidiaries Moove Sympany and Kolping). moneyland.ch expects to see more insurers offer this model in the future.
The unbiased health insurance comparison by moneyland.ch lists all pharmacy-model offers and clearly marks them as such. Eligible pharmacies are listed on the information pages of each insurance policy.
Swica Favorit Medpharm and Provita Medpharm
The Swica Favorit Medpharm model (and the Medpharm model of Swica subsidiary Provita) was launched in 2016 in cooperation with TopPharm pharmacies. It was the first pharmacy model to be launched in Switzerland.
Swica Favorit Medpharm policyholders can choose between consulting the Sante24 medical hotline or a Swica partner pharmacy as a first stop. In this case, all TopPharm pharmacies function as Swica gatekeepers.
Consulting the telemedicine line or an eligible pharmacy first is obligatory. Additionally, the choice of doctors for your first medical examination is limited to doctors who are on the Medpharm list.
Casamed Pharm from Sympany and PharmHelp24 from Kolping
Casamed Pharm from Sympany is also offered by Sympany subsidiaries Moove Sympany and Kolping (under the PharmHelp24 product name).
Policyholders are required to visit a Sympany partner pharmacy as a first stop in the event of health problems. Currently more than 120 TopPharm pharmacies are part of the Sympany network (as of 2016).
Policyholders receive consultation in a private room within the pharmacy. Depending on the need, a doctor can be brought in via a video or telephone call. This is accomplished via a collaborative effort between TopPharm pharmacies and Medgate.
Simple tests can be performed by the pharmacist directly at the pharmacy. Depending on the case, patients will be referred to a general doctor, specialist or hospital.
If visiting a pharmacy is not possible, policyholders can also contact Medgate directly via the telemedicine hotline. Children can only be insured by a policy using the Casamed Pharm model if at least one parent is also covered by a Casamed Pharm policy.
Alternative pharmacy models
Aside from actual pharmacy-model health insurance policies, many forms of cooperation between Swiss health insurance providers and pharmacies also exist.
For example, if you hold a PharMed health insurance policy from Assura, only medicines which you buy at pharmacies with which Assura has a partnership will be covered. Because the list of Assura partner pharmacies is minimal, it is advisable to proceed with caution and make sure that partner pharmacies are within easy reach.
Special privileges offered by pharmacies for holders of policies from certain insurance providers are another type of insurance-pharmacy cooperation. For example, until December 31, 2016, CSS policyholders can receive a complimentary pain-relief consultation at TopPharm pharmacies.
Health insurance comparison (all models)