Medication and generics: what Helsana will cover

Sometimes medication is the best solution for your health. The Federal Office of Public Health (FOPH) determines which medication can be covered by basic insurance and compiles the lists of medication covered by statutory health insurance in Switzerland. The costs of medication are paid only if the following applies: The medication must have been prescribed by a doctor and either included in the specialities list or manufactured in accordance with the list of medicines with tariffs:

• Speciality list (SL): The FOPH creates the specialities list for medication and updates it monthly.  It contains all medication approved by Swissmedic that the FOPH assesses for efficacy, expediency and cost-effectiveness. The specialities list includes original medication, generic medication and also homeopathic, phytotherapeutic and anthroposophic medicines.
  
  
• List of medicines with tariff (LMT): The current list of medicines with tariffs can be found as a PDF on the FOPH medication page. The LMT regulates the prices, active ingredients and excipients for medicines produced in pharmacies, such as ointments, capsules or tinctures. 

Savings tip: Under basic insurance, you pay an excess for medication, usually 10%. However, you pay a 40% excess for medication for which there is a cheaper alternative with the same active ingredient. So always ask for generic medication or biosimilars. 

Supplementary insurance expands the range of medication covered by Helsana. It covers medication not covered by statutory health insurance or off-list medication. The prerequisites for medication covered by supplementary insurance are: 

• The pharmaceutical product is approved by the Swiss Agency for Therapeutic Products, Swissmedic, but is not included in the specialities list or the LPPV (more on this below). 
• You have a medical prescription for the medication.
  

How much does your supplementary insurance pay for medication?

Coverage for medication not covered by statutory health insurance depends on your choice of supplementary insurance:

• With TOP supplementary insurance, you receive 90% of the cost of medically prescribed medication not covered by basic insurance. Medication included in the list of pharmaceutical products with special uses (LPPV) or the supplementary list are excluded. 
  
  
• With SANA supplementary insurance you receive 75% of the cost of complementary medicine medication prescribed by a doctor or naturopath that is not covered by basic insurance. This is subject to the condition that the treatment is carried out by a doctor or a naturopath recognised by Helsana or by a person recognised by Helsana as a paramedical therapist in a field of complementary medicine.
  
  
• With COMPLETA supplementary insurance, you receive 90% of the cost of conventional medication and 75% of the cost of complementary medicine remedies that are not covered by your basic insurance. This is subject to the condition that the remedy used is recognised by the Swiss Agency for Therapeutic Products Swissmedic. Medication on the list of pharmaceutical products with special uses (LPPV) are excluded.

There are medication products that are not covered by basic or supplementary insurance. They are listed in the list of products with special uses (LPPV) or its supplementary list. These include, in particular, products designed to enhance general well-being, such as dietary supplements, cosmetics and dietary products. Here is a list of medication not covered by health insurance:

You can help keep your own costs and overall healthcare costs low. This is possible if you opt for a cheaper generic medication. Why are generic medication and biosimilars cheaper than original medication? Medicinal products are protected by patents. When the patent expires, generic medication or biosimilars can be produced. The active ingredient has already been tested in the original medication. This eliminates expensive research-and-development costs.

Would you like to switch to cheaper medication? Get advice from a pharmacy or your general practitioner. However, not every medication has a generic version or biosimilar.