- Generics are cheaper compared to original preparations.
- In addition, patients’ deductibles increase if they choose the more expensive product despite having the same active ingredient.
- The Federal Council wants to save around 250 million francs annually.
The corresponding revision of the Health Insurance Ordinance (KVV), the Nursing Benefits Ordinance (KLV) and the Medicines Ordinance (VAM) will come into force on January 1, 2024. The state government decided this on Friday.
The focus is on the sale of generics and copycat products, the so-called biosimilars. These equally effective and cheaper medicines are used less often in Switzerland than abroad.
Legend:
Twice as expensive in Switzerland as abroad: generics.
Keystone/GAETAN BALLY
Increase the price difference to the original
The Federal Council is now intervening in the pricing of certain generic and copycat medicines with chemical active ingredients because they are around twice as expensive as abroad. In 2020, Parliament rejected the introduction of a reference price system and instructed the government to make adjustments at the regulation level and enable savings.
For generics of active ingredients with a market volume of four to eight million francs, the price difference to the original preparation will now be increased from 30 to 40 percent. The price gaps applied as part of the triennial review will be increased by 5 percent.
When reviewing generics for which there is no longer an original preparation with the same active ingredient in the specialty list, a therapeutic cross-comparison (TQV) with other generics should now be carried out to assess the cost-effectiveness. These generics could no longer be verified.
Biosimilars up to 70 percent cheaper
The Federal Council also acts on biosimilars. To date, copycat preparations have been considered economical when included in the specialty list if they are at least 25 percent cheaper than the original biological preparation. As part of the three-yearly review, they must be 10 percent cheaper.
The economic viability of biosimilars is now also assessed both when they are included in the specialty list and during the periodic review, analogous to generics, taking into account market volume-dependent levels with price differences to the reference preparations of between 20 and 70 percent.
Increased deductible
From the beginning of 2024, patients’ deductibles when purchasing expensive original preparations will also be increased. The deductible is generally 10 percent of the costs exceeding the deductible. However, medicines are subject to a deductible of 20 instead of 10 percent if they are too expensive compared to medicines with the same active ingredients.
This “increased” deductible will be set at 40 percent with the revision of the regulation. The rules for differentiated deductibles now also apply to biosimilars.
If medical reasons speak against the delivery of a generic, you can still purchase a more expensive original preparation without an increased deductible. But this must be proven again with concrete facts.
According to the Federal Council, all of these measures should lead to a cost reduction of around 250 million francs annually. The savings potential is “significant”.