Generics

What are generics?

Generics are medicines that contain the same active ingredient as an original product that is already authorised. They come onto the market when the original’s patent protection has expired. Because the manufacturer does not have to fund its own research into the active ingredient, generics are cheaper. In Switzerland, Swissmedic authorises every generic before it may be sold.

In basic health insurance, the topic is closely linked to the retention fee. The insurer pays for medicines that are on the FOPH’s List of Pharmaceutical Specialties and prescribed by a doctor. For expensive products for which cheaper alternatives with the same active ingredient exist, however, the law requires a higher retention fee: the differentiated retention fee of 40%.

Biosimilars are a special form. They are copies of medicines produced using biotechnology. For the differentiated retention fee, the same rules apply to them as to generics.

How it works

For every active ingredient on the List of Pharmaceutical Specialties, the Federal Office of Public Health (FOPH) determines the cheapest third of all products and calculates the average of their ex-factory prices. If a medicine is at least 10% above this average, you pay a 40% instead of a 10% retention fee on the costs after the deductible. This applies equally to originals, generics, co-marketing products and biosimilars. So a generic can also be subject to the higher retention fee if it is more expensive than its cheapest competitors.

The threshold is set each year on 1 December or when the first generic of an active ingredient is added to the list. If a manufacturer lowers its price below the threshold, the normal 10% retention fee applies to its product again.

The higher retention fee does not apply if your doctor demonstrably prescribes the original for medical reasons or if the pharmacy refuses a switch for medical reasons. Doctors’ practices and pharmacies must inform you if a generic exists for your medicine and if the retention fee is above 10%.

For the annual maximum retention fee of CHF 700, the share above 10% counts only by half. So if you choose expensive originals, you reach the cap more slowly and pay more overall.

Legal basis

The right of substitution is set out in Art. 52a of the Federal Health Insurance Act (KVG): if several medicines with the same active ingredient composition are on the List of Pharmaceutical Specialties, the pharmacy may dispense a cheaper one if it is equally suitable from a medical point of view, unless the original is expressly requested (para. 1). It informs the person who issued the prescription (para. 2).

The differentiated retention fee is governed by Art. 38a of the Health Care Benefits Ordinance (KLV), in force in its current version since 01.01.2024. Para. 1 sets the threshold of 10% above the average of the cheapest third and the retention fee of 40%, para. 2 lists the products concerned, para. 7 the exception for medical reasons and para. 8 the duty to inform. The basis is Art. 64 para. 6 let. a KVG, under which the Federal Council may provide for a higher co-payment for certain benefits, and Art. 104a para. 1bis of the Health Insurance Ordinance (KVV). Under Art. 104a para. 2 KVV, the part above the statutory retention fee only counts by half towards the annual maximum.

The price gap on admission to the list is governed by Art. 65c para. 2 KVV: depending on the market volume of the original, a generic must be at least 20%, 40%, 50%, 60% or 70% cheaper. For an original with more than CHF 25 million in sales a year, it is 70%.

Example: one year of a long-term medicine

Sara is 52, has the standard deductible of CHF 300 and has already used it up this year. She needs twelve packs of a medicine. The prices are assumptions for the calculation: the original costs CHF 60 a pack and is above the threshold; a generic costs CHF 36 and is below it. The retention fees of 10% and 40% are the statutory values under Art. 38a KLV.

	Original	Generic
Cost of 12 packs	CHF 720.00	CHF 432.00
Retention fee	40%	10%
Sara’s share	CHF 288.00	CHF 43.20
Counted towards the CHF 700 maximum	CHF 180.00	CHF 43.20

Your choice does not change the premium. Generics do, however, affect the costs of the whole system and therefore premiums in the long run. You can see how the insurers are doing under health insurers, and the 2026 premiums of all insurers in the premium calculator.

What this means for you

With every new prescription, ask whether there is a generic. This is especially worthwhile for medicines you take long term. Three points will help you:

1. Check the List of Pharmaceutical Specialties. On the List of Pharmaceutical Specialties, you can see for every product whether a 10% or 40% retention fee applies.
2. Clarify medical reasons. If you do not tolerate an excipient or a switch is delicate, your doctor should prescribe the original expressly and with a reason. The normal retention fee then applies.
3. Do not think only in terms of original versus generic. Generics can also be above the threshold. Compare several products with the same active ingredient.

As long as you have not yet reached your deductible, you pay the full price of every medicine yourself. The price difference between the original and the generic then counts directly. The entry medicine prices explains more about prices and how they are set. You will find more terms on basic health insurance in the glossary.

Common mistakes

• Thinking generics always have a 10% retention fee. What counts is the price, not the label. An expensive generic can also cost 40%.
• Asking for the original without a reason. Without a documented medical reason, the higher retention fee applies.
• Confusing the retention fee with the deductible. The differentiated retention fee only applies after the deductible; before that, you pay everything yourself anyway.
• Assuming the CHF 700 cap fully protects you. The additional share above 10% only counts by half towards the maximum.

How we calculate examples is explained under how we calculate.