In certain cases, medical treatment with medicines may be the right solution. Many medicines are covered by basic insurance, but if you have supplementary insurance, you will be reimbursed part of the cost of even more medicines.
In Switzerland, compulsory basic health insurance covers the costs of prescription medicines that are included on one of the following lists:
The list of specialities (SL) contains the medicines that are covered by the basic insurance. This list provides information about the preparations and generics that are paid for by the basic insurance. However, they are only covered if they have been prescribed by a specialist in the form of an appropriate certificate.
The list of medicines with tariff (ALT) contains medicines that are not on the SL but are nevertheless covered by the basic insurance. This list is also maintained by the FOPH. The medicines on the ALT are covered by the health insurance if they are prescribed by a doctor and are medically necessary.
Health insurance companies in Switzerland may refuse to cover the costs of medicines in the following cases:
It is important to check the terms of your health insurance and the current SL and ALT lists to know exactly which medicines are covered. If you have any questions about the coverage of medications, you should contact your health insurance provider directly.
Health insurance does not usually cover over-the-counter medications, dietary supplements or medications that are not on the SL or ALT and are not considered medically necessary. Medicines used for cosmetic purposes are also not usually covered by the health insurance.
The supplementary insurance covers "medicines not subject to compulsory health insurance" from Swissmedic (LPPV). Swissmedic (LPPV) is responsible for authorising medicines in Switzerland. These medicines must be exclusively curative and may not contain any comfort or lifestyle products. Supplementary insurance covers up to 90% of the costs of these medicines.
The supplementary insurance plans of Sanitas,Helsana and Sympany pay for other medicines that are not covered by the basic insurance plan. These supplementary insurances are listed below:
|Health insurance||Supplementary insurance||Cost coverage|
|Sanitas||Classic||90 % of the costs for "non-payable" medicines|
|Helsana||Completa,Top||90 % of the costs for "non-payable" medicines|
|Sympany||Ambulante Zusatzversicherung (Plus & Premium)||90 % of the costs for "non-payable" medicines|
|Groupe Mutuel||Global Classic||90 % of the costs for "non-payable" medicines|
|Swica||Completa Top||90 % of the costs for "non-payable" medicines|
|CSS||MyFlex Ambulantversicherung||90 % of the costs for "non-payable" medicines|
|Concordia||Diversa Plus||75 % of the costs for "non-payable" medicines|