Understanding the medication system in Switzerland
Switzerland’s healthcare insurance covers the cost of prescripted medications, as part of the Swiss Mandatory Health Insurance (MHI) scheme. Approximately one-third of medications in Switzerland are available only with a prescription, while the remaining two-thirds can be purchased at a pharmacy.
In order to obtain a prescription, you need to see a doctor who will provide you with a written prescription for the medication you require.
Prescription medications in Switzerland can only be dispensed by licensed pharmacists or healthcare providers with prescription-writing privileges. These medications typically require a prescription from a healthcare provider, such as a physician or a practitioner, and are usually more potent or have a higher risk of adverse effects compared to OTC (Over-the-Counter Medicines) medications. Prescription medications are usually covered by the mandatory health insurance scheme in Switzerland, although some may require co-payments from patients.
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SwissMedic has classified medications in Switzerland into four categories:
A – This category includes drugs with the most stringent regulations. Medications like opioids cannot be refilled under this category.
B – Drugs in this category require a prescription, but refills are allowed.
D – Medications in this category do not require a prescription, but professional guidance is necessary.
E – This category comprises drugs with no restrictions on supply and can be purchased without a prescription over the counter.
Pharmacies and medication
Pharmacies are responsible for providing the required medications. Patients are required to present their insurance cards for payment purposes. The pharmacies will then issue a full receipt to the health insurance company, which will subsequently provide a 10% receipt to the patient. Some pharmacies may allow customers to pay the 10% portion in cash. Health insurance covers 90% of the cost, with patients responsible for only 10%.
If you have health insurance but have not yet received your insurance card, you must pay for the medication upfront and then submit the receipt to the insurance company for reimbursement.
Health insurance coverage
Swiss health insurance covers the cost of medication. Swiss residents are required to pay an annual deductible, and in addition to this, a 10% coinsurance fee to help cover their medical expenses.
When purchasing basic health insurance, individuals have the option to choose their insurer within their home canton. The Federal Council sets the range of potential deductibles, and insurers are free to propose various guarantees with different deductible levels and corresponding premiums.
Several measures are in place to protect patients from incurring high out-of-pocket costs. Firstly, individuals under the age of 18 are exempt from deductibles. Secondly, there is an annual cap on co-insurance payments for both adults and children. Moreover, certain situations exempt individuals from paying the full cost of care or a portion of it. For instance, copayments do not apply to routine pregnancies, and federal public health programs provide services such as flu shots during pandemics and mammograms for breast cancer screening, without deductibles.
While hospitalized patients with insurance may need to pay for some costs, the hospital does not itemize the bills nor exclude medication expenses from the overall cost. The hospital creates a report of expenses that may include medications priced at any level if the patient does not have basic health insurance or if their stay is not covered. As a result, if the patient lacks basic insurance, the medication costs listed may exceed the maximum reimbursement price.
When buying insurance, it is crucial to examine all the specifics with an insurance broker and opt for additional coverage that meets your specific needs. It’s worth noting that there are other insurance providers that frequently strike deals with hospitals that offer pricing arrangements and the appropriate coverage.