Medication costs increased significantly in 2021 and now stand at more than CHF 8 billion. This is primarily driven by new medical treatments with very high price points. The authorities are increasingly using secret pricing for high-cost medication. Price models containing confidential prices are becoming the rule rather than the exception. Overall, almost 40% of the preparations added to the list between 2015 and 2021 were governed by this type of pricing model. The Helsana report also looks at the following: are women being properly served in terms of medication with regard to possible pregnancy? Plus, new preventative treatment for migraines is put to the test.
Medication costs borne by basic insurance exceeded the CHF 8 billion mark for the first time in 2021. Costs grew considerably more than in the previous year (+4.6%), as did both the number of people purchasing medications (+1.3%) and the number of medications purchased (+0.5%). This development is mainly down to isolated highly expensive medications for treating various cancers and tumours.
For years now, the rankings for the most expensive drug groups have remained unchanged. The top spot is still occupied by immunosuppressants. These generated an impressive CHF 1,217 million in 2021, or 15% of the total costs. In second place are the cancer drugs, amounting to 12% or CHF 971 million of the total costs.
Since 2020, Switzerland has seen growing numbers of “pricing models” being used for setting medication prices. In many cases, this is because a manufacturer does not accept the prices determined using the conventional method, leading to delays in approval. Many pricing models involve confidential agreements between the Federal Office of Public Health (FOPH) and the pharmaceutical companies. As this approach breaches the transparency requirements set out in the Freedom of Information Act, it is now set to be excluded from the Act and legalised as part of the Federal Council’s second package of measures to reduce costs. The proportion of new medications subject to pricing models is increasing year on year: while 17 new approvals with a pricing model were added to the specialities list in 2015, this figure rose to 76 in 2021. Overall, 39% of the preparations added to the list between 2015 and 2021 were governed by a pricing model. Public bodies and pharmaceutical companies argue that pricing models make access quicker and result in cost savings. Pricing models with confidential prices can help facilitate access to innovative treatments thanks to the additional flexibility they offer. However, they do not contribute to curbing the costs in this respect.
It has long been known that taking medication during pregnancy carries a risk. However, it cannot always be avoided. To back this up, analysis of the data from 2021 revealed that 87.7% of all pregnant women purchased at least one medicinal product. Some medications can be particularly harmful for an unborn child and should therefore definitely be avoided. Teratogenic drugs can result in foetal abnormalities if taken during pregnancy. In 2021, 14.4% of all women of childbearing age purchased teratogenic drugs. Among women under 26, these were most commonly acne treatments that are classed as recognised strong teratogens. It is pleasing to note that, in most cases, women switched to safe alternatives prior to becoming pregnant. Nevertheless, 1.3% of pregnant women did take potentially harmful teratogens in the first trimester of their pregnancy.
Alongside tension headaches, migraines are one of the most common types of headache. Long-term preventive treatment is advertised for patients who are particularly severely affected. In 2018, the first example of a new active ingredient group for migraine treatments, so-called CGRP antibodies, came onto the Swiss market. This new drug group appears to be both well tolerated and effective against certain types of migraine. There are concerns from an economic perspective, however, as the annual costs of treatment with CGRP antibodies are many times higher than the costs of conventional standard preventive treatments. Long-term CGRP purchasers saw medication costs rise by a remarkable 82%. Three-quarters of this rise was solely attributable to CGRP antibodies. However, current study data shows that CGRP antibodies only lead to a slight reduction in the number of migraine days; this justifies the strict limitation regarding the specialities list, but not the high costs.
We're here to help.