What medications are covered by health insurance?

Which medications are covered by health insurance?

In Switzerland, compulsory basic insurance covers the costs of prescription drugs that appear on one of the following lists:

Specialty List (SL)

The specialty list (SL) contains the medicines that are covered by basic insurance. This list is kept by the Federal Office of Public Health (BAG) and updated regularly. The medicines listed on the SL are covered by health insurance if they have been prescribed by a doctor and are medically necessary.

Drug list with tariff (ALT)

The drug list with tariff (ALT) contains drugs that are not on the SL but are still covered by basic insurance. This list is also maintained by the BAG. The medicines on the ALT are covered by health insurance if they have been prescribed by a doctor and are medically necessary.

Which medications are covered by supplementary insurance?

The supplementary insurance covers the "non-insurable medicines" from Swissmedic (LPPV). Swissmedic (LPPV) is responsible for the approval of medicines in Switzerland. These medications must be purely therapeutic and must not contain any comfort or lifestyle products. Most supplementary insurances cover 90% of the costs of these medications.

Which patients are not subject to health insurance contributions?

In Switzerland, every inhabitant is generally required to contribute to compulsory health insurance. However, there are some exceptions, such as diplomats, certain international organizations or people working in Switzerland on a short-term basis. These people may have to take out private health insurance or provide evidence of foreign insurance that meets the requirements of Swiss law.

Which patients are not subject to health insurance contributions?

Drugs are not on the specialty list (SL) or the drug list with tariff (ALT):
The health insurance only covers the costs for medicines that are on one of these lists and have been prescribed by a doctor.
Not medically necessary:
If a drug is not considered medically necessary, the health insurance company can refuse to cover the costs.
Over-the-counter medicines:
Health insurance usually does not cover the cost of over-the-counter medications or dietary supplements unless they are medically necessary and prescribed by a doctor.
Cosmetic purposes:
Drugs used for cosmetic purposes are usually not covered by health insurance.
Experimental or unapproved drugs:
The health insurance company can refuse to cover the costs of medicines that have not yet been officially approved or are considered experimental.
inefficiency:
In some cases, the health insurance company can refuse to cover the costs if a drug is considered uneconomical, i.e. if there are cheaper and equivalent alternatives.
Missing medical prescription:
The health insurance company can refuse to cover the costs if there is no doctor's prescription for the drug.

It's important to check your health insurance terms and current SL and ALT lists to know exactly what medications are covered. If you have any questions about the reimbursement of medication, you should contact your health insurance company directly.

Which medications are not covered by health insurance?

Health insurance usually does not cover the cost of over-the-counter medications, dietary supplements, or medications that are not listed on the SL or ALT and are not considered medically necessary. Medicines that are used for cosmetic purposes are also usually not covered by health insurance.

Which pregnancy medications are covered by health insurance?

The health insurance covers the costs for pregnancy medications that have been prescribed by a doctor and are listed on the SL or ALT. These can include, for example, folic acid supplements, iron supplements or medication for pregnancy symptoms.

How do prescriptions work in Switzerland?

In Switzerland, prescriptions work as follows:

Prescription by healthcare professionals:
A doctor, dentist or other authorized healthcare professional prescribes a drug by writing a prescription. The prescription contains information about the patient, the drug prescribed, the dosage, the duration of use and, if necessary, special instructions.
Pharmacies:
After the patient has received the prescription, he can redeem it in a pharmacy. The pharmacy provides the medication according to the information on the prescription and provides information on how to take it correctly and possible side effects.
Health insurance coverage:
If the prescribed drug is on the list of specialties (SL) or the list of drugs with tariff (ALT), compulsory basic insurance will cover the costs if the drug is medically necessary. However, the patient must pay the statutory deductible and deductible.
Deductible and excess:
In Switzerland, patients pay an annual deductible (franchise) and a deductible of 10% of the cost of medical services, including medication. There is an upper limit for the deductible, which is adjusted annually. Once the upper limit has been reached, the health insurance company covers 100% of the costs for recognized medical services.
Additional insurance:
If the medication is not covered by basic insurance, the patient can check whether their supplementary insurance will cover the costs. The conditions and extent of the assumption of costs vary depending on the selected insurance model.

It is important that patients know their health insurance terms and keep their prescriptions safe as they may be needed for billing the health insurance company.