Pharmacy model: the pharmacy first
In the pharmacy model a pharmacy is your first point of contact when you have a complaint. It advises you, treats simple cases itself or refers you to a doctor. For this restricted choice the insurer gives you a premium discount; the benefits stay the same.
How the Pharmacy model works
The pharmacy model is also insurance with restricted choice of service provider (Art. 41 para. 4 KVG). The pharmacy takes on the role of first point of contact: it assesses whether you can treat yourself or need a doctor.
Up to 2026 the FOPH does not list pharmacy tariffs as a separate type: depending on the insurer, they are included in the tariff type “HAM” (GP) or “DIV” (other models). From 2027 there is a separate tariff type “PHARM”.
What you pay compared with the standard model
| City | Standard (free choice of physicians) | GP/HMO | Telemedicine/digital | Flex |
|---|---|---|---|---|
| Zurich (ZH) | CHF 677.00 | CHF 598.42−11.6 % | CHF 597.05−11.8 % | CHF 597.00−11.8 % |
| Bern (BE) | CHF 699.75 | CHF 617.95−11.7 % | CHF 622.95−11.0 % | CHF 603.30−13.8 % |
| Lausanne (VD) | CHF 720.80 | CHF 637.60−11.5 % | CHF 639.00−11.3 % | CHF 624.30−13.4 % |
| Lugano (TI) | CHF 764.00 | CHF 684.40−10.4 % | CHF 689.55−9.7 % | CHF 687.45−10.0 % |
| City | Standard (free choice of physicians) | GP/HMO | Telemedicine/digital | Flex |
|---|---|---|---|---|
| Zurich (ZH) | CHF 549.75 | CHF 470.45−14.4 % | CHF 471.50−14.2 % | CHF 472.20−14.1 % |
| Bern (BE) | CHF 571.45 | CHF 490.10−14.2 % | CHF 494.60−13.4 % | CHF 475.00−16.9 % |
| Lausanne (VD) | CHF 592.50 | CHF 512.00−13.6 % | CHF 511.00−13.8 % | CHF 496.00−16.3 % |
| Lugano (TI) | CHF 635.70 | CHF 556.10−12.5 % | CHF 561.40−11.7 % | CHF 562.50−11.5 % |
Our own calculation: median of all tariffs per model in the city municipality (premium region 1), percentage compared with the median of the standard model. “Telemedicine and other models” is the FOPH tariff type “DIV” up to 2026; besides telemedicine it also includes other models. Source: FOPH, health insurance premiums 2027, as at 15.10.2026, opendata.swiss. Methodology: How we calculate.
What do I need to do before seeing a doctor?
Most insured people are in a model like this: in 2024, according to the FOPH, 79.8% of adults and 83.1% of children. If you do not know the rules, you risk your insurer not paying for a treatment.
Pharmacy · Emergency
In an emergency you go straight to the nearest emergency department or call 144, without a referral and without calling first. Many tariffs require you to inform your pharmacy afterwards within a deadline. How long that deadline is depends on the insurance conditions.
Important: The insurance conditions of your tariff are binding. You will find them in your policy or on your insurer’s website. The rule above describes what many tariffs provide, not your contract.
Legal basis: Art. 41 para. 4 KVG
Suits you if …
- you are rarely ill and like to sort out simple complaints at the pharmacy
- you have no regular GP
- you prefer advice in person rather than on the phone
Watch out for
- Not every insurer offers a pharmacy model, and not in every municipality.
- Which pharmacies are allowed and when you may go directly to a doctor is in the insurance conditions.
More in the glossary
Frequently asked questions
What is a pharmacy model?
A basic health insurance model in which you first go to a pharmacy when you have a complaint. The pharmacy advises you and refers you to a doctor if needed. In return the premium is lower.
Why do you not show a discount for the pharmacy model?
Because pharmacy models cannot be evaluated separately in the FOPH premium data: depending on the insurer, their tariffs are included in “GP” or “Telemedicine and other models”. Assigning tariffs by name would be guesswork. As soon as the FOPH lists pharmacy tariffs separately, we will show real figures here.
What happens if I do not follow the rules of the model?
If you see a doctor without following the required route, the insurer does not have to pay for that treatment (Art. 41 para. 4 KVG). Many insurance conditions also provide for exclusion from the model after repeated breaches. Emergencies are always exempt.
When can I change my model?
You can switch from the standard model to a model with restricted choice at any time. Returning to the standard model or switching to another model is only possible at the end of a calendar year; your notice must reach the insurer one month in advance, i.e. by 30 November (Art. 100 KVV, Art. 7 KVG).
Sources
- Federal Health Insurance Act (KVG), Art. 41Art. 41 KVGfedlex.admin.ch
- Health Insurance Ordinance (KVV), Art. 99–101aArt. 99–101a KVVfedlex.admin.ch
- FOPH: Health insurance, special types of insurancebag.admin.ch
- FOPH: health insurance premiums, opendata.swissopendata.swiss
- FOPH: Statistics on compulsory health insurance 2024, tables T 7.08 and T 7.09 (as at 22.05.2025)bag.admin.ch
Calculation based on the 2027 premiums approved by the FOPH, as at 15.10.2026, source: FOPH, health insurance premiums, opendata.swiss. Only the insurer’s quote or policy is binding. The model descriptions and rules are general information, not individual advice; your insurer’s insurance conditions are binding. Methodology: How we calculate.