Key points at a glance
- The prices on the List of Pharmaceutical Specialties are binding maximum prices for pharmacies, doctors’ practices, hospitals and nursing homes (Art. 67 para. 1 KVV).
- The retail price is made up of the ex-factory price, the distribution share and VAT (Art. 67 para. 2 KVV).
- The FOPH reviews all medicines on the list every three years and lowers prices that are too high with effect from 1 December (Art. 65d KVV).
- The FOPH sets the cost-effective price half on the basis of an international price comparison and half on a therapeutic cross-comparison (Art. 65b KVV).
What are medicine prices?
In health insurance, medicine prices are the prices that pharmacies, doctors’ practices and hospitals may charge for medicines covered by basic health insurance. These prices are not set by the market but by the Federal Office of Public Health (FOPH). It publishes them in the List of Pharmaceutical Specialties (SL), a public list of all medicines that basic health insurance pays for.
The prices on the list are maximum prices. Nobody may charge basic health insurance more. This protects you twice: as long as you have not yet reached your deductible, you pay the price yourself; after that, you pay the retention fee on it. In both cases, the same maximum price applies, no matter which pharmacy you get the medicine from.
Medicines that are not on the list, for example many over-the-counter products, have no official price. As a rule, basic health insurance does not pay for them. Some supplementary insurance policies cover part of the cost; this depends on the contract.
How it works
The price you see in the pharmacy is called the retail price. It consists of three parts:
- Ex-factory price: it covers production and distribution up to the warehouse in Switzerland. The FOPH formally decides it.
- Distribution share: it covers logistics, i.e. storage, transport, staff and capital costs. For prescription-only medicines, it consists of a percentage mark-up and a fixed mark-up per pack.
- VAT.
The FOPH checks whether the ex-factory price is cost-effective. It compares the price with the prices of the same medicine in reference countries (international price comparison) and with other medicines for the same disease (therapeutic cross-comparison). Each of the two values counts for half.
Once a medicine is on the list, its price is not fixed. The FOPH divides all medicines into three groups and reviews each group every three years. If the price is too high, it orders a reduction with effect from 1 December. If a manufacturer wants to raise the price, it needs approval, no earlier than two years after the medicine was added to the list or after the last increase.
Separate rules apply to generics: when they are added to the list, they must be at least 20% to 70% cheaper than the original, depending on the original’s sales. If a medicine is significantly more expensive than the cheapest ones with the same active ingredient, you pay a 40% instead of a 10% retention fee.
Legal basis
Art. 52 para. 1 let. b of the Federal Health Insurance Act (KVG) instructs the FOPH to draw up a list of pharmaceutical specialties with prices. Under Art. 52 para. 3 KVG, medicines may be charged to basic health insurance at no more than these prices.
The details are set out in the Health Insurance Ordinance (KVV). Art. 65b KVV defines cost-effectiveness and weights the international price comparison and the therapeutic cross-comparison equally (para. 3). Art. 65c KVV governs the price gap for generics, and Art. 65d KVV the review every three years with price reductions taking effect on 1 December (para. 4). Art. 67 para. 1 KVV declares retail prices to be binding maximum prices, para. 2 lists their components and para. 5 the conditions for price increases.
The amount of the distribution share is set out in Art. 38 of the Health Care Benefits Ordinance (KLV). For prescription-only medicines with an ex-factory price of up to CHF 4,720.99, the percentage mark-up is 6%; above that, it is 0%. The mark-up per pack is CHF 9 up to an ex-factory price of CHF 7.99, CHF 16 from CHF 8 to CHF 4,720.99 and CHF 300 from CHF 4,721. For over-the-counter medicines, the mark-up is 80% of the ex-factory price. Since 01.07.2024, a uniform distribution share has applied to medicines with the same active ingredient (Art. 67 para. 4bis KVV).
Example: how the price is made up
The table calculates the distribution share for three prescription-only medicines with assumed ex-factory prices. The mark-ups are the statutory values from Art. 38 KLV. VAT is added in each case and is not included here.
| Ex-factory price | Percentage mark-up | Mark-up per pack | Price before VAT |
|---|---|---|---|
| CHF 5.00 | 6% = CHF 0.30 | CHF 9.00 | CHF 14.30 |
| CHF 50.00 | 6% = CHF 3.00 | CHF 16.00 | CHF 69.00 |
| CHF 5,000.00 | 0% = CHF 0.00 | CHF 300.00 | CHF 5,300.00 |
The example shows why large packs are often cheaper for long-term medicines: the fixed mark-up is charged per pack, not per tablet. You can see how much basic health insurance costs in total from the 2026 premiums in the premium calculator.
What this means for you
You cannot negotiate prices, but you can influence what you pay:
- Ask about generics. If there is a cheaper medicine with the same active ingredient, you save the full price difference before reaching your deductible and often 30 percentage points of retention fee after that.
- Check the pack size. For medicines you take over a long period, talk to your doctor about the largest pack that makes sense.
- Look up prices. The List of Pharmaceutical Specialties shows the retail price and the retention fee for every product.
- Know which medicines are not covered. Anything that is not on the list you pay yourself or through supplementary insurance.
High medicine costs are a reason to reconsider your deductible. If you regularly need expensive medicines, you will almost certainly reach your deductible. You will find the key figures for each insurer under health insurers. The debate about a reference price system is explained in a separate entry.
Common mistakes
- Thinking the pharmacy sets the price itself. For medicines covered by basic health insurance, the maximum price on the List of Pharmaceutical Specialties applies.
- Underestimating the distribution share. For low-cost medicines, it can be more than the ex-factory price.
- Expecting every price reduction immediately. After its review, the FOPH lowers prices with effect from 1 December, not on an ongoing basis.
- Assuming over-the-counter products are covered. Basic health insurance only pays for what is on the List of Pharmaceutical Specialties and prescribed by a doctor.
You will find more terms on tariffs and costs in the glossary.
Frequently asked questions
Who sets medicine prices in Switzerland?
For medicines covered by basic health insurance, the FOPH sets the maximum price and publishes it in the List of Pharmaceutical Specialties. The FOPH formally decides the ex-factory price, while the Federal Department of Home Affairs (FDHA) sets the distribution share in the KLV. There is no official price for medicines that are not on the list.
Why does the same medicine cost the same in every pharmacy?
Because the List of Pharmaceutical Specialties contains binding maximum prices. Pharmacies, doctors’ practices and hospitals may not charge basic health insurance more. The distribution share is calculated in the same way for all service providers.
How often are medicine prices lowered?
The FOPH reviews every medicine on the list every three years. If the price is too high, it orders a reduction with effect from 1 December of the review year. A price increase requires approval and is possible no earlier than two years after the medicine was added to the list or after the last increase.
Does basic health insurance also pay for medicines that are not on the List of Pharmaceutical Specialties?
As a rule, no. The insurer pays for medicines on the List of Pharmaceutical Specialties that a doctor has prescribed. Exceptions in individual cases are governed by Art. 71a–71d KVV and usually require cost approval in advance.
Related terms
- List of Pharmaceutical Specialties (SL)The List of Pharmaceutical Specialties (SL, Spezialitätenliste) is the Federal Office of Public Health’s list of all medicines paid for by basic health insurance, together with their maximum prices. A medicine is only added if Swissmedic has authorised it and it is effective, appropriate and cost-effective. As a rule, basic health insurance does not pay for anything that is not on the SL.
- GenericsGenerics are copies of an original medicine with the same active ingredient, launched after the patent has expired. In basic health insurance, they are cheaper and protect you from the differentiated retention fee: if your medicine is significantly more expensive than the low-cost alternatives, you pay a 40% instead of a 10% retention fee.
- Reference pricing systemA reference pricing system sets a maximum price that the health insurer reimburses for medicines with the same active ingredient; if you want a more expensive product, you pay the difference yourself. The Federal Council proposed it in 2019, and Parliament rejected it. Instead, a 40 % retention fee now applies to overpriced products.
- MedicinesBasic health insurance pays for medicines if a doctor prescribes them and they are on the FOPH’s List of Pharmaceutical Specialties, at most at the price set there. You pay the deductible and a 10% retention fee, or 40% for expensive original products with cheaper alternatives. You pay for medicines not on the list yourself or through supplementary insurance.
- SwissmedicSwissmedic, the Swiss Agency for Therapeutic Products, is the federal authority that authorises and supervises medicines and medical devices. A medicine may only be sold in Switzerland if Swissmedic has authorised it. Whether health insurance pays for it, however, is decided not by Swissmedic but by the FOPH with the List of Pharmaceutical Specialties.
- Weight-loss injectionA weight-loss injection is a medicine such as Wegovy or Mounjaro that you inject once a week to lose weight. Basic health insurance only pays for it with cost approval: from a BMI of 35, or from 28 with a related condition, together with a diet and nutritional advice, prescribed by specialised physicians or obesity centres and for three years at most.
Sources
- Health Insurance Ordinance (KVV), Art. 67Art. 67 KVVfedlex.admin.ch
- Health Insurance Ordinance (KVV), Art. 65bArt. 65b KVVfedlex.admin.ch
- Health Insurance Ordinance (KVV), Art. 65dArt. 65d KVVfedlex.admin.ch
- FDHA Ordinance on Benefits in Compulsory Health Insurance, Health Care Benefits Ordinance (KLV), Art. 38Art. 38 KLVfedlex.admin.ch
- Federal Health Insurance Act (KVG), Art. 52Art. 52 KVGfedlex.admin.ch
- FOPH, List of Pharmaceutical Specialties (SL)spezialitaetenliste.ch