The costs of basic insurance for medicines rose in 2022. Overall, costs amounted to CHF 8.5 billion in the outpatient sector, an increase of CHF 360 million compared with the previous year. In order to ensure the continued financing of real innovations, new pricing rules and cost-cutting measures such as volume discounts are needed. Helsana has been analysing the development of the pharmaceutical market in Switzerland for the past ten years.
Medication can potentially have a positive impact on the progression of diseases and on patients’ quality of life. On the other hand, the costs relating to medication are high and the medication sometimes fails to deliver on what it promises, is not used in accordance with the latest medical knowledge or is disproportionately expensive.
Our figures show that the use of medication is on the up, with more and more people taking medication and the quantity of medication used per person rising. One aspect stands out: new medications are often very expensive and usually have package prices of over CHF 1,000. These new treatments are not always an improvement on the previous ones, and only 4 out of the 45 new ingredients in medications in 2022 could be termed as innovative. “The public must be confident that they will not have to pay excessive prices for medicines, particularly in the case of pseudo-innovations,” emphasises Manuel Elmiger, the healthcare economist responsible for the Helsana Drug Report. To determine this, we need to take a clear, unbiased look at the developments at hand – and this is precisely what the tenth Helsana Drug Report provides.
Last year, 6.8 million people (+5.2% more than in the previous year) purchased 127 million packs of medication (+3.7%), resulting in a total additional cost of CHF 360 million (+4.4%). The cost increases are primarily a result of relatively new medication in the high-price segment. This leads to very high per capita costs for modern treatments, such as cancer, diabetes and cystic fibrosis treatments. Cancer drugs alone cost over CHF 1 billion, while representing just 0.7% of all packs purchased on the market. Modern monotherapies for the treatment of cancer are extremely expensive and now cost CHF 30,000 or significantly more per person per year. If different expensive medications have to be combined in one treatment, the costs are particularly high. The widespread disease diabetes has seen costs increase by CHF 50 million, resulting in total costs of CHF 411 million in 2022.
There are significant differences in per capita medication costs from region to region. Reasons for this include, for example, demographics, individual preferences and contrasts in the range of services on offer. Ticino, parts of north-western Switzerland and the canton of Geneva have 25% higher expenditure per capita than parts of central Switzerland and some cantons in eastern Switzerland.
“The Drug Report shows that increasingly expensive products are being taken. The population feels the impact of this every year in the form of rising health insurance premiums,” says Helsana CEO Roman Sonderegger. Volume-related prices would slow down the growth of costs. Up to now, the quantity of packs sold or the revenue, or rather the total costs of an individual treatment, have not been a criterion for price setting. The sales of an individual medication can therefore increase unchecked. If a medication is sold more frequently, this should necessarily lead to a price reduction above a certain revenue threshold. When new medications receive approval, better checks should be performed to assess whether the medication is really an innovation with a high level of benefit.
Although there are clear criteria for pricing, the prices are often determined by means of secret negotiations between the pharmaceutical industry and the Swiss Federal Office of Public Health (FOPH). The public ultimately bear the costs and should therefore know how the prices are negotiated between the pharmaceutical industry and the FOPH. Last but not least, the pharmaceutical market also offers equally effective but cheaper products, both original and equivalent products. Increased use of these alternatives would offer greater savings potential, which has not yet been tapped into to a sufficient extent.
It is often difficult to keep track of what medication you have taken, especially when several service providers, such as hospitals, general practitioners and pharmacies, are involved. Helsana billing data gives patients an overview of this. Starting this week, users can find a list of all the medication they have received and submitted for billing in the “myHelsana” application. Any insured persons can share this overview with their doctors and pharmacists.
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