Performance-based remuneration (LOA)

What is performance-based remuneration?

Performance-based remuneration, LOA for short (from the German Leistungsorientierte Abgeltung), is the tariff of public pharmacies in basic health insurance. It does not pay for the medicine but for the work of the pharmacist when dispensing it: checking the prescription, looking for interactions, explaining the dosage, keeping a patient record or suggesting a cheaper generic.

The Federal Health Insurance Act (KVG) expressly counts this work as a benefit of basic health insurance: the services of pharmacists when dispensing medicines prescribed by a doctor (Art. 25 para. 2 let. h KVG). Art. 4a KLV specifies exactly which services these are: advice when filling a doctor’s prescription with at least one medicine on the List of Pharmaceutical Specialties, filling a prescription in an emergency outside opening hours, replacement with a cheaper medicine with the same active ingredients, and supervision of intake ordered by a doctor.

According to the FOPH, pharmacists’ services have been remunerated separately from the price of the medicine since 2001; the first tariff agreement was approved on 20.02.2002. Version LOA V has applied since 01.01.2026. It replaces LOA IV/1, which had applied since 01.01.2016.

The LOA only concerns medicines on a doctor’s prescription that are paid for through basic health insurance. If you buy a medicine without a prescription for self-medication, there are no LOA items. Medicines covered by a supplementary insurance do not fall under this tariff either.

How it works

The LOA is a tariff agreement in two parts. The tariff structure agreement between prio.swiss and pharmaSuisse sets the tariff items and their tax points for the whole of Switzerland. The tariff agreements between pharmaSuisse and prio.swiss, the purchasing group HSK and CSS set the value of one tax point in francs. In the agreement with CSS it is CHF 1.40 excluding VAT throughout Switzerland. Because the agreement applies to the whole country, it was approved by the Federal Council (Art. 46 para. 4 KVG).

The items are billed only for medicines “subject to LOA”: products on the List of Pharmaceutical Specialties in Swissmedic dispensing categories A and B, magistral preparations according to the list of medicines with tariff, and medicines with cost approval under Art. 71a–71c KVV (Art. 3 tariff structure agreement LOA V).

The most important items from Annex A of the tariff structure agreement:

All amounts in francs excluding VAT, rounded to the nearest centime. A medicine counts as “new” if you have not obtained the active ingredient from this pharmacy in the last 365 days. The medicine safety check is charged per prescription line, the patient safety check at most once per day and per prescriber.

If the pharmacy replaces an original product with a generic or a biosimilar, it bills a “savings share”: 40% of the price difference according to the List of Pharmaceutical Specialties goes to the pharmacy and 60% stays with the insurer, up to CHF 40 excluding VAT (Art. 11 Annex A). Only the first substitution is remunerated, not every repeat.

Legal basis

The service itself is anchored in Art. 25 para. 2 let. h KVG: basic health insurance covers the services of pharmacists when dispensing medicines prescribed by a doctor. Art. 4a para. 1 of the Health Care Benefits Ordinance (KLV) lists the services that are remunerated (advice, emergencies, substitution, supervision of intake). Under Art. 4a para. 2 KLV, further cost-containing services for a group of insured persons can be covered within the framework of a tariff agreement.

The tariff structure is based on Art. 43 para. 5 KVG, which requires a uniform structure for fee-for-service tariffs throughout Switzerland. Under Art. 46 para. 4 KVG the agreement requires the approval of the Federal Council because it applies to the whole of Switzerland. The Federal Council approved LOA V on 29.10.2025. The price of the medicine itself is not part of the LOA: it appears as the public price in the List of Pharmaceutical Specialties and is made up of the ex-factory price, the distribution share and VAT (Art. 67 para. 2 of the Health Insurance Ordinance, KVV).

Example: a prescription with two medicines

Eva is 61 and fills a prescription at her regular pharmacy in 2026. It contains a category B medicine she has been taking for years and a new category B medicine. The pharmacy bills under LOA V at the point value of CHF 1.40 from the agreement with CSS:

If the pharmacy suggests that Eva take a generic at CHF 40 instead of an original product with a public price of CHF 60 and she agrees, the price difference is CHF 20. The pharmacy may bill 40% of this, i.e. CHF 8, as its savings share; the insurer saves CHF 12.

What this means for you

• Read your pharmacy invoice. The LOA items are listed individually on the invoice or the reimbursement claim form. This shows you what is the medicine and what is the advice.
• Stick to one regular pharmacy. Whether a medicine is classed as “new” or “existing” depends on the record held by the pharmacy where you fill the prescription. If you change pharmacy, a medicine counts as new there again and the check costs more.
• Ask about generics. Substitution is remunerated for the pharmacy and saves basic health insurance money.
• Check the pharmacy model. Some insurers offer a pharmacy model in which the pharmacy is your first point of contact. Whether it pays off for you is shown by the comparison in the premium calculator; you can find an overview of the insurers under health insurers.

Common mistakes

• Taking LOA for an extra fee. The LOA is an approved tariff of basic health insurance. The pharmacy may not charge more than this tariff.
• Thinking the insurer always pays the LOA. The items count towards your deductible and retention fee like any other benefit.
• Expecting LOA for self-medication. Without a doctor’s prescription there are no LOA items; you pay for the medicine entirely yourself.
• Alternating between several pharmacies. Your patient record then has gaps, and the higher “new” items are charged more often.