SWITZERLAND Law and Practice Contributed by: Oliver Brupbacher, Markus Schott, Markus Wang and Djamila Batache, Bär & Karrer Ltd
approach to assessing cost-effectiveness. Swiss Par- liament and the Federal Council seek to strengthen the security of supply for medicinal products that might otherwise be withdrawn from the Swiss market due to insufficient profitability. To this end, low-cost, low-revenue medicines reimbursed under the com- pulsory health insurance will no longer be subject to a cost-effectiveness assessment by the FOPH as part of the triennial review of efficacy, appropriateness and economic efficiency (Article 32 para. 3 of the nHIA and Article 65d para. 1bis of the nHIO). Consequently, their prices will no longer be subject to reductions. 8.5 Regulation of Prescriptions and Dispensing by Pharmacies Although the main purpose of the prescribing and dis- pensing regulations is to safeguard patient welfare and safety in the dispensing and use of medicinal products by requiring that only HCPs with sufficient education, training and continuing education are involved (Arti- cles 24–26 of the TPA), HCPs are required by their professional duties and corresponding provisions in their self-regulations to also observe the aspect of economic efficiency. Furthermore, the legal provisions on the advertising of medicinal products explicitly provide for the inadmissibility of advertising (includ- ing to HCPs) that may encourage the excessive use of medicinal products (cf Article 32 paragraph 1 lit b of the TPA). Lastly, the integrity provisions (cf the OIT and Article 55 of the TPA) prohibit the excessive prescribing of medicines.
In general, physicians may prescribe any authorised medicinal product for a given indication without regard to its price and they are not obliged to propose a more affordable (generic) alternative. That said, if the SL contains different medicinal products containing the same API, the cost share that must be borne by the patient may vary. Physicians must inform their patients accordingly. Equally, for medicinal products that are not included in the SL or that are used off-label or off-limitation, HCPs must inform the patients that the costs might not be reimbursed under the compulsory health insurance. According to Article 52a of the HIA, pharmacists are allowed – but not obliged – to sub- stitute a prescribed original medicinal product listed on the SL with a generic unless there is an explicit request by the prescribing physician or chiropractor to dispense the original.
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