SWITZERLAND
Accessibility
Affordability
The available evidence suggests that for people living with diabetes accessibility is not the main barrier to obtaining medicines and medical devices.5,6 • Although some stock issues due to delays at the manufacturer or wholesalers levels may affect specific products,5,6 alternatives can be offered to people with diabetes in order that their treatment is not impacted upon by these difficulties.6
Looking ahead Discussions are on-going to improve diabetes care and support (holistic approach, improved education and information).5,6
• Due of the fee applied to diabetes products, all people with diabetes have to pay out-of-pocket for their treatment up to a ceiling of CHF 700 (USD 733) per year. However, these costs appear not to be considered a barrier.5 o Depending on each region’s agreement with the insurers, some people have to pay up front for their diabetes products before being reimbursed by their insurance.6 o According to respondents to our survey,5 the median monthly out-of-pocket payment for diabetes medicines and medical devices was CHF 60 (USD 63) or CHF 720 (USD 758) per year. This corresponds to the out-of-pocket ceiling mentioned earlier. It constitutes 2.5% of the average Household Net Adjusted Disposable Income – as much as 6% for the least wealthy 20% of households. • Although few non-branded products are available, and despite incentives to encourage the use of such products, it appears most people with diabetes use branded products. Moreover, the choice of brand is strongly influenced by healthcare providers.5 • The maximum prices for diabetes supplies are negotiated with the manufacturers by the Federal Office for Public Health.5 The mark-ups applied by wholesalers and pharmacists are regulated5 and were recently reduced for pharmacists.7 Taxes apply to medicines as well as medical devices. However, medicines benefit from a reduced VAT rate of 2.5% and are exempt from import duties.4,5
Financial coverage The Federal Office for Public Health decides on reimbursement, according to efficacy, indications and cost-effectivness.3 Although all the surveyed products are on the list of fully reimbursed products (see also Availability), a fee is applied to all diabetes medicines and medical devices.6 Reimbursements are made by the health insurance companies. The table below presents only coverage offered by the basic care package without taking into account additional coverage through complementary health insurance. Insulin and anti-diabetes medication
Free1,6 but fees apply5,6
Medication for hypoglycaemia
Free but fees apply5,6
Pens and related supplies
Free1 but fees apply and a limit on needles may also apply5,6
Syringes and needles
Free but fees apply6
Pumps and related supplies
Free1 but fees apply5,6
Blood glucose test strips and meters
Free but fees apply 5,6 – limit of 400 per year for people who are not on insulin6,8
Ketone test strips
Free but fees apply5,6
Please note that the information above presents only a summary of the reimbursement system and may not apply to individual cases.
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References 1 EURADIA, FEND, IDF, & PCDE. (2011) 2 Global health observatory data repository. (2013) 3 “Prestations” (2012) 4 Swiss Federal Office of Public Health & WHO. (2011). 5 IDF-Europe Access survey (2013) 6 Swiss Diabetes Association (personal communication) (2013) 7 Vogler, S. et al. (2011) Southern Med Review. 8 Huber C. (personal communication) (2013) 9 Mutual recognition agreements. (2013).