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The FOPH determines which medications are reimbursed by basic insurance. Criticism is raised among pharmaceutical companies.
Before a new drug is included on the so-called specialty list, it has to go through a complex set of tests. Among other things, the authorities at the Federal Office of Public Health BAG make price comparisons with other countries and similar medicines. At the end of the procedure, the drug may be on the list with the price calculated by the BAG. And every three years, the BAG reviews the entire list and the prices.
The list and the prices – both give the pharmaceutical industry something to talk about, says Marcel Plattner, President of the industry association vips: “Our members cannot understand many of the decisions. Every day we have two to three pharmaceutical managers who contact us with problems in this regard.»
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Basic insurance reimburses all medicines that the FOPH puts on the list of specialties. But in order to get on this list, medicines have to meet certain criteria and, for example, be “economical”. But what that means in a specific case is open to debate.
key stone
Now the vips association has commissioned a study that shows where the problems lie. It was carried out by the University of St. Gallen. The focus is on those companies that have lodged complaints against BAG decisions. That’s a minority.
But their dissatisfaction has a common denominator, as Daria Lenherr-Segmüller from the University of St. Gallen says: “The surveys revealed that the BAG only uses its leeway from the point of view of the industry to unilaterally promote the cost reduction goal – without the supply goal being appropriate to be taken into account.”
In part, the practice of the BAG was described as arbitrary in the industry survey.
In other words: keeping the cost of medicines low is more important for the FOPH than the broad supply of medicines. That’s why newer drugs that are expensive are either not on the list at all or, from the pharmaceutical company’s point of view, at a price that is too low. Lenherr-Segmüller says it is difficult for those surveyed to understand how the BAG comes to its decisions and it is also unpredictable: “In some cases, the practice of the BAG was described as arbitrary in the industry survey.”
Marcel Plattner from the pharmaceutical industry knows the allegation from practice: Among other things, the comparisons with other medicines that are made to set the price caused confusion. “Constantly changing comparison baskets, comparisons with outdated therapies or symptom therapies are compared with healing therapies, etc.”
The FOPH is responsible for ensuring that the health system and in particular the premiums remain affordable for the population. The BAG is therefore pursuing a different goal than a pharmaceutical company.
The BAG refers to its discretionary powers: for example, it may decide at its own discretion which medicines to use for price comparisons and justify its choice. Jonas Montani from the BAG says: “The BAG is responsible for ensuring that the health system and in particular the premiums are affordable for the population. The BAG is therefore pursuing a different goal than a pharmaceutical company.”
In individual cases, medication is still reimbursed
Differences are inevitable, says Montani. But from the point of view of Marcel Plattner from the vips pharmaceutical association, the companies are not concerned with having as many drugs as possible on the list at high prices. “Having a product on the specialty list does not guarantee any sales at all. However, a large number of products on the list of specialties ensures that the patient has a good variety of therapies.»
And it enables security of supply, according to Plattner. However, if the prices for medicines in Switzerland are too low, the pharmaceutical companies would at best not offer them in Switzerland because the effort is not worth it. If a drug is not on the list at all, there is the possibility that an individual health insurance company will still reimburse it, but these are often expensive individual regulations.