The Federal Council wants to save 250 million francs on health care costs

Generic drugs are cheaper compared to original preparations. In addition, patients’ deductible is increased if they choose the more expensive product, despite having the same active ingredient. The Federal Council wants to save approximately 250 million francs annually.

The related revision of the Health Insurance Regulation (KVV), the Nursing Benefits Regulation (KLV) and the Medicines Regulation (VAM) will come into effect on January 1, 2024. The state government decided this on Friday.

The focus is on the sale of generic and copycat products, the so-called biosimilars. These equally effective and cheaper drugs are used less often in Switzerland than abroad.

The Federal Council is now intervening in the pricing of certain generic and copycat medicines with chemical active ingredients, because they are approximately twice as expensive as abroad. In 2020, Parliament rejected the introduction of a reference price system and ordered the government to make adjustments at regulatory level and enable savings.

For generic medicines with active ingredients with a market volume of four to eight million francs, the price difference with the original preparation will now be increased from 30 to 40 percent. The price differences applied in the context of the three-year review will be increased by 5 percent.

When assessing generic medicines 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 generic medicines must now be carried out to assess cost-effectiveness. These generics could no longer be verified.

The Federal Council also deals with biosimilars. Until now, copycat preparations are considered economical if they are included on the specialty list if they are at least 25 percent cheaper than the original biological preparation. As part of the three-year review, they must become 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 with the reference preparations of between 20 and 70 percent .

From the beginning of 2024, patients’ deductibles when purchasing expensive original preparations will also be increased. The deductible is typically 10 percent of costs that exceed the deductible. However, medicines have 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 scheme. The rules for a differentiated deductible now also apply to biosimilars.

If there are medical reasons that contradict the supply 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 these measures should lead to cost savings of approximately 250 million francs per year. The savings potential is “significant”.

The Federal Council is making further changes to the so-called individual case allowance. In this case, health insurers decide whether they will reimburse the costs of a medicine.

A 2020 evaluation by the Federal Office for Public Health (BAG) showed that similar cases are assessed unevenly by health insurers. In addition, the complex price negotiations and the lack of transparency in individual remuneration were experienced as problematic.

Uniform rules now apply for assessing benefits, pricing and security of supply. If the request for cost authorization is rejected, health insurers must from now on always justify the decision to the treating physician and the patient based on the benefit assessment carried out.

The third package of measures includes measures to optimize processes when including medicines on the specialty list. The Federal Council wants to accelerate access to essential medicines and the treatment of rare diseases by up to three months. In exceptional cases, inclusion on the specialty list must take place without delay at the same time as market approval.

(sda)