Generic drugs: what does health insurance cover?

1. What is a generic drug?

Generics are copies of previously patented drugs and contain the same active ingredient. In other words: the active substance of the copycat corresponds to that of the original drug.

Generics must also have the same dosage and dosage form as the original medicine

Not every drug is available as a generic. Also, a drug may only be copied after patent protection has expired.

2. When should I choose the original medication?

Other ingredients in the preparation may cause the body to respond to a generic differently than the original. For example, a generic tablet may include lactose where the original did not; this could be an issue for people with lactose intolerance. It may therefore be medically necessary in certain cases to use the original medication.

A switch from a proprietary drug to a generic should thus be carried out under medical supervision. This is especially true for drugs where a precise dosage at a certain point in time and a long-term effect with a steady level of the active ingredient are very important.

Examples include anti-epileptic drugs, psychiatric medicines, or drugs taken after transplants.

If in doubt, ask the prescribing doctor or the dispensing pharmacist.

3. What is the generics list?

Like all other drugs, generics must be approved by Swissmedic (the Swiss Agency for Therapeutic Products) and shown in the list of pharmaceutical specialties.

The list contains a specific generics list. The O/G column shows whether it is an original preparation (O) or a generic (G). (Not available in English.)

4. Will basic health insurance cover the cost of generics?

Yes. According to the Health Insurance Act, products on the list of pharmaceutical specialities must be covered by compulsory basic insurance minus any out-of-pocket expenses. The same goes for generics.

What costs do health insurers cover for generics?

As with all medical benefits covered by basic insurance, a deductible initially applies to medicines. Basic health insurance does not pay anything up to this maximum amount.

After that, a coinsurance of 10% is charged – up to 700 francs per calendar year. Basic insurance thus covers 90% of the cost of medicines.

After reaching 700 francs, basic insurance covers the entire cost.

Additional costs for original drugs

The coinsurance may increase from 10% to 40% if the original drug is significantly more expensive than an equivalent generic drug.

This means you may have to pay more for the original than for the generic. However, this only applies if the use of a generic drug raises no concerns from a medical point of view.

5. Is it worth taking out supplemental insurance for medicines?

Various outpatient supplemental insurance policies will cover a portion of the cost of drugs not covered by basic health insurance. A coinsurance payment of 10% also usually applies.

Some drugs are not reimbursed by either basic nor supplemental insurance. These are shown in the list of pharmaceutical products for special applications (or LPPV list).