Pharmacy model

What is the pharmacy model?

The pharmacy model is one of the special types of insurance in basic health insurance. You undertake to go to a pharmacy first if you have health problems, instead of going straight to a doctor. The pharmacy thus takes on the role that the GP has in the GP model and the telephone advice service has in the telemedicine model.

The idea behind it: many complaints such as colds, minor injuries or skin problems can be assessed at a pharmacy. The pharmacy can give advice, dispense non-prescription medicines and recognise when a medical examination is needed. This saves expensive visits to the doctor, and the insurer passes on this cost advantage as a discount.

Legally, the pharmacy model is an insurance with a restricted choice of service provider. It is part of basic health insurance under the Federal Health Insurance Act (KVG), not of supplementary insurance. The term itself does not appear in the law; each insurer designs its model and its name itself.

How it works

The process roughly looks like this; each insurer sets the details itself:

1. First contact at the pharmacy. You take your concern to a pharmacy that works with your insurer. In some cases, telephone advice is part of the model.
2. Advice and triage. The pharmacy assesses the situation. In simple cases you receive a recommendation or a medicine.
3. Referral. If medical treatment is needed, the pharmacy refers you on, for example to a GP or a telemedicine centre. This referral works like a referral from a doctor.

Which pharmacies belong to the model, which exceptions apply and what happens if you do not follow the process are set out in the insurance terms and conditions. In such models, some insurers waive the deductible and retention fee in full or in part for certain services; the law allows this but does not require it.

The premium is lower than in the standard model. The ordinance limits how large the discount may be: it must be based on real cost differences of the model, not on healthier insured persons. As long as a model has no experience figures from five financial years, it may be at most 20% cheaper than the same insurer’s ordinary insurance.

Legal basis

Under Art. 41 para. 4 KVG, you can, in agreement with the insurer, restrict your choice to service providers selected by the insurer for more cost-effective care. The insurer then only has to pay for services provided or ordered by these service providers. The statutory compulsory benefits are insured in any case. Art. 62 para. 1 KVG allows a lower premium for this.

The KVV governs the details. Art. 99 para. 2 KVV allows the insurer to waive the deductible and retention fee in full or in part in such models. Art. 100 para. 2 KVV allows you to switch into the model at any time, and Art. 100 para. 3 KVV allows a switch to another form of insurance for the end of a calendar year, with the notice periods under Art. 7 para. 1 and 2 KVG. Art. 101 para. 2 and 3 KVV limit the premium reduction. Under Art. 101a KVV, special types of insurance are not open to persons resident in the EU, Iceland, Norway or the United Kingdom.

Example: tariffs linked to a pharmacy in Zurich

Sabrina is 36, lives in the city of Zurich and has the CHF 2,500 deductible. In the FOPH premium data for 2026 she finds three tariffs whose names indicate a pharmacy as the point of contact. The FOPH assigns them to the model group “GP/HMO”. Premiums 2026, municipality of Zurich (region 1), born in 1990, with accident cover; source FOPH.

Insurer and tariff	Per month	Per year
Sympany, “casamed pharm”	CHF 418.20	CHF 5,018.40
Assura, “PharMed”	CHF 422.80	CHF 5,073.60
SWICA, “FAVORIT MEDPHARM”	CHF 436.80	CHF 5,241.60
Standard model, median of 27 offers	CHF 511.50	CHF 6,138.00

The table is not a recommendation. It only shows how large the gap to the standard model can be in one municipality. You can see all offers for where you live and your year of birth in the premium calculator, and an overview of the insurers under health insurers.

What this means for you

The pharmacy model suits you if you rarely need medical help and have a pharmacy near you that works with the insurer. Check before switching:

1. Partner pharmacies: Is there a participating pharmacy near you, with opening hours that fit your daily life?
2. Referral: How do you get to a doctor if the pharmacy cannot help, and do you also need a referral for this?
3. Ongoing treatment: If you are being treated by a specialist, check whether the treatment can continue without interruption.
4. Exceptions: Which services, such as emergencies, are exempt from the process?

The model finder helps you choose. The entry telemedicine model describes the model with initial advice by telephone.

Common mistakes

• Confusing the model with insurance for medicines. The pharmacy model governs the first contact, not payment for medicines.
• Going straight to the doctor. If you do not follow the agreed route, you risk the insurer not paying the bill.
• Only looking at the discount. If there is no partner pharmacy nearby, daily life becomes complicated.
• Planning the switch back too late. You can only return to the standard model at the end of the year, with the notice period under Art. 7 KVG. Dates under deadlines.