The Ordinance on Integrity and Transparency in the Therapeutic Products Sector (OITTP) came into force on 1 January 2020 and governs the acceptance of discounts by service providers and how these discounts are passed on to health insurers.
Service providers were previously obliged to pass any discounts they received on to health insurers in full. Under the revised Therapeutic Products Act (TPA) in force since 1 January 2020, service providers only have to pass on the majority of discounts provided that the retained portion is demonstrably spent on measures to improve the quality of treatment.
Service providers and health insurers are to set out the terms in an agreement. In the absence of any such agreement, it is assumed that the service provider either does not receive any discounts or passes them on in full.
If service providers pass on and use discounts in accordance with the law, they gain access to financial resources that they can use to drive continuous improvements in treatment quality. This, in turn, increases patient satisfaction and helps make service providers more cost-effective.
Insured persons benefit from service provider discounts through redistribution via premiums, which increase more slowly as a result. Patients of participating service providers also benefit from improved treatment quality.
Helsana offers the following agreement variants for service providers:
The HSK Purchasing Cooperative has concluded a national framework agreement with CSS and the Swiss Medical Association (FMH). The agreement governs the partial retention of discounts under Art. 56(3)(b) in conjunction with (3bis) of the Federal Health Insurance Act (KVG) and includes suggested quality improvement measures. Individual service providers or their organisations can sign up to the agreement.
This variant is suitable for service providers who negotiate discounts themselves as it means they do not have to pay another service provider to conduct the negotiations on their behalf.
Helsana, along with CSS, Sanitas and tarifsuisse, has concluded agreements with the service provider ProMedicus. Service providers benefit from pre-negotiated discounts, regulated passing on of discounts and suggested quality improvement measures – including regulated reporting of these measures.
This variant is particularly suitable for specialists and their organisations that wish to delegate responsibility for negotiations with the pharmaceutical industry to a specialist service provider.
Helsana also offers individual bilateral agreements. These are particularly suitable for operating companies and doctor’s networks, with whom Helsana maintains an ongoing dialogue.
The HSK and tarifsuisse purchasing cooperatives have teamed up with CSS to offer a joint contract solution that covers all health insurers and the people insured with them.
The HSK and tarifsuisse purchasing cooperatives and CSS are currently in negotiations over a Swiss-wide contract solution. If you have any questions, please call us on 058 340 64 73.
Since the implementation required by the legislator is difficult to achieve at short notice, Helsana is offering alternative solutions for a transitional period. Please contact us to discuss possible options.
Helsana’s aim is to improve the quality of medication. A distinction is made between core measures and additional measures. Core measures are a prerequisite for an OITTP agreement with Helsana. There are already automated technical solutions available that offer transparency with regard to medication, drug interaction checks and dosage adjustment. Additional measures are also accepted provided they are not already settled via other tariffs. The impact of all measures should be verifiable by an independent body.
Helsana has defined transparency with regard to medication as a core measure. This means that every doctor can view a patient’s medication during medical history-taking and diagnosis and can incorporate it into their treatment. This transparency allows for computer-based checks of drug interactions and dosages.
You do not have to fill out the agreement. We will be happy to help you define quality measures so that you can spend a portion of the discounts on them.
Download the national framework agreement from the HSK-CSS website or contact HSK. Return two signed copies of the framework agreement for countersigning.
No. Details can also be agreed with the relevant health insurer by e-mail or over the telephone. Helsana endeavours to promote uniformly applicable quality measures in order to minimise the administrative burden for service providers.
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