Medicine prices and margins
Various false incentives and inadequate regulations affect the pricing and approval of medicines today. This means that medication in Switzerland is still more expensive than medication abroad and that unreasonable price demands by the industry go unchallenged.
Many new, high-priced medicines will be licensed in the coming years. This raises pressing questions about financial feasibility and how to curb rising costs in relation to new medication and therapies. The current set of rules is not equipped to respond adequately to new developments such as the personalisation of medicine, the handling of uncertainty where there is a lack of evidence or the evaluation of combination products. Under the approved second package of cost-containment measures (MNP2), the following measures have been adopted to curb medication costs in the long term:
- Cost impact models (Art. 52e KVG): 'Cost impact models' provide for an automatic discount to be introduced for medicines with a high sales volume when those sales exceed a certain threshold. The Federal Office of Public Health (FOPH) is required to take various aspects, such as product-specific circumstances or the number of reimbursed indications, into account. Cost impact models derive from a motion previously introduced by Member of the Council of States J. Dittli, which curafutura helped to craft. This approach is a useful tool for containing the rise in costs for high-volume medication. The two-year transitional period and rules on exceptions address considerations regarding security of supply. During implementation, it must be ensured that the targeted savings potential can actually be achieved (e.g. level of sales thresholds, rules on exceptions not too broadly interpreted).
- Provisional reimbursement from day 0 (Art. 52d KVG): In future, medicines for which there is great medical demand may be reimbursed for a limited period on application by the marketing authorisation holder and following a hearing by the Federal Medicines Commission (EAK) from the moment they are approved by Swissmedic at a provisional price determined by the FOPH, with conditions attached regarding any potential reimbursement obligation. The FOPH must decide on definitive inclusion in the Specialties List within 24 months. It is important that provisional reimbursement does not drive up costs and that it is restricted to truly innovative medication. In addition, care should be taken to ensure that the provisions are implemented as restrictively as possible at the ordinance level.
- Differentiated WZW assessment (Art. 32 para. 3 KVG): Depending on the type of service, the Federal Council may now prescribe different frequencies for assessing the WZW criteria (effective, appropriate and cost-effective), and may stipulate that only individual criteria need to be assessed. The ordinance must ensure that high-volume medicines are not excluded from this assessment by means of exceptions.
The measures adopted in 2023 (promoting generics and biosimilars, changes to the distribution markup and revised margins) are starting to bear fruit. Initial evaluations show that the measures are driving down costs.
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