Reimbursement and costs

Specific treatments, except CCB, are very expensive with prices ranging from 12’000.- to 120'000.- CHF annually for a single drug. Reimbursement by basic health insurance (KVG/LaMal) depends on: 

  1. Indications recognized by Swissmedic and published in the Swiss Drug Compendium  and 
  2. The list of specialities published by the Federal Office of Public Health (OFSP/BAG) 

The prescriber must consult both sources because neither of them gives full information: the Swiss Drug Compendium gives “recognized indications” for each drug (eg “idiopathic PAH and PAH associated with connective tissue disease in functional class III”) while the list of specialties gives the list of medication that are paid by basic health insurance. “Recognized indication” is a necessary but not sufficient condition for re-imbursement. For example, the list of specialties may indicate that a particular drug with recognized indication still requires previous approval by the health insurance’s medical adviser (Vertrauensarzt/médecin conseil) for re-imbursement (so-called “Limitatio”). Dispositions are different and are expressed in different terms for each drug.