Medication: Cost coverage by health insurance

Which medicines are covered by health insurance?

In Switzerland, compulsory basic health insurance covers the costs of prescription medicines that are included on one of the following lists:

Speciality List (SL)

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.

List of medicines with tariff (ALT)

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.

When does the health insurance not pay for medicines?

Health insurance companies in Switzerland may refuse to cover the costs of medicines in the following cases:

• Medicines are not on the speciality list (SL) or the list of medicines with tariff (ALT): the health insurance company will only pay for medicines that are on one of these lists and have been prescribed by a doctor.
• Not medically necessary: If a medicine is deemed not medically necessary, the health insurance fund may refuse to cover the costs.
• Over-the-counter medicines: As a rule, the health insurance fund does not cover the costs of over-the-counter medicines.
• Cosmetic purposes: Medicines are not covered by health insurance if they are used for cosmetic purposes.
• Experimental or unauthorised medicines: The health insurance fund may refuse to cover medicines that have not yet been officially approved or are considered experimental.
• Uneconomical: In some cases, the health insurance fund may refuse to cover the costs if a medicine is deemed uneconomical, i.e. if there are cheaper and equivalent alternatives.
• Lack of a doctor's prescription: The health insurance fund may refuse to cover the costs if there is no doctor's prescription for the medication.

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.

Which medicines are not covered by health insurance?

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.

Which medicines does the supplementary insurance pay for?

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.

Which supplementary insurance plans pay for other 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: