The public price of reimbursable medicines subject to a complex set of regulatory interventions. In order for a pharmaceutical to be reimbursable, it has to be admitted to the so-called Specialties List (“SL”) drawn up by the Federal Office of Public Health (“FOPH”). The criteria for a pharmaceutical to be included in the SL are efficacy, suitability and cost-effectiveness of the medicine concerned.
In view of recent decisions by the Federal Administrative Court (“FAC”) and the Federal Supreme Court, the Federal Government revised the federal ordinances to the Swiss Health Insurance Act (“SHIA”) and introduced significant amendments relating to the criterion of cost-effectiveness. In particular, for each triennial review of the continued compliance with this criterion, not only a comparison with the average ex-factory prices abroad is drawn. Also, a therapeutic cross-comparison must be established to evaluate the cost-benefit-ratio more appropriately.
For more information, including a table outlining the original process and the new amendments, please see the Vischer newsletter here.