Swiss Health Insurance: Pharmacy Model Compared

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.

There are also numerous mixed models and variations in the pharmacy model. For example, some health insurers offer models where you can choose between a pharmacy, a telemedicine service and/or a family doctor's office as your first point of contact.

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

In Switzerland, the pharmacy models of Assura, Groupe Mutuel, ÖKK, Sanitas, Swica and Sympany are currently on the market. 

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

The Swica Favorit Medpharm model 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. 

Consulting the telemedicine line or an eligible pharmacy first is obligatory. Additionally, the choice of doctors is limited to doctors who are on the Medpharm list.

Casamed Pharm from Sympany

Insureds are required to visit one of Sympany's partner pharmacies as a first point of contact for health problems or to contact Medgate by phone or app. 

At the pharmacy, insured persons are advised by pharmacists in a dedicated room. Depending on the need, a doctor can also be connected directly via video or telephone. If you do not agree with the suggestions of the pharmacist, you can ask Medgate for a second opinion or contact a general practitioner or specialist (provided this has been agreed with the pharmacy).

Pharmacists can perform simpler tests directly at the pharmacy. Depending on the case, patients are referred to a general practitioner, specialist or hospital.

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.

More on this topic:
Health insurance comparison (all models)