With pharmaceutical products, a distinction is made between original preparations and generic drugs. Generic products are imitations of medicines whose patent protection has expired. Since their development costs are low, generics are cheaper than the corresponding originals. However, there is not always a generic to every medicinal product.
If a policyholder buys an original preparation without a medical reason even though a generic would have been available, he/she has to pay a retention of 20 percent. If the price difference between the original and the generic product is less than 20 percent, the retention stays at 10 percent.
Medicines are pharmaceutical products that serve to heal, prevent or diagnose an illness at a certain dosage. Medicines may be made from plants or animals or be of synthetic origin.
They have to be approved by the Swiss Agency for Therapeutic Products, Swissmedic, in order to be sold in Switzerland.
Reimbursement by health insurance
Pursuant to the Health Insurance Act (KVG), medicines need to be demonstrably efficient, useful and cost-effective in order for them to be reimbursed by basic insurance minus a contribution to costs. These pharmaceutical products are on the Specialties List issued by the Federal Office of Public Health (FOPH).
There is no difference between conventional and complementary medicines in terms of reimbursement by basic insurance. Drugs used in complementary medicine are likewise covered by basic insurance minus a contribution to costs if they are on the Specialties List.
Various types of outpatient supplemental coverage pay for products that are not or only partially covered by basic health insurance.
There are medicines that are not reimbursed by either basic or supplemental insurance. These are pharmaceutical products from the List of Pharmaceutical Products for Special Purposes (LPPV).