Medicines/drugs: costs covered by Sanitas

Regardless of whether you just need a pill for a headache or if you have a prescription for a drug from the doctor, It’s important to know which medicines are covered by health insurance. Find out how much Sanitas pays towards the costs of medicines here.

There’s a simple rule: health insurance covers only medicines prescribed by a doctor. But that’s not the only requirement. Which medicines/drugs and how much of the costs are covered is largely regulated by law. The regulatory requirements leave little room for manoeuvre.

What costs are covered by basic insurance?

The Swiss Federal Health Insurance Act (HIA) specifies which medicines have to be covered by health insurers. Basic insurance covers the costs of medicines that are:

• Prescribed by a doctor
  
• Included in the list of pharmaceutical specialities and used in accordance with any applicable limitation
• Or produced according to a prescribed recipe as per the pharmaceutical list with tariffs
  

What costs are covered by supplementary insurance?

Supplementary insurance plans cover higher amounts and costs for additional medicines. The Sanitas plans cover the following costs for medicines/drugs:

• Vital Basic, Vital Smart and Vital Premium cover 90% of the costs of medically prescribed drugs that are not covered under basic insurance.
• The medicine must be registered with Swissmedic for treatment of the illness in question, and must not be on the list of uninsured drugs
  

• If the above criteria are met, additional alternative medical remedies are reimbursed, provided they are handed out or prescribed by a natural health practitioner recognised by Sanitas.
  

Save money with generics

Once the patent protection for a drug has expired, it may be copied. Generic products contain the same active ingredients in the same dosage as the original drug and are – in almost all cases – interchangeable. However, they cost less because the development costs are lower.

If you opt for a generic product, you usually pay a copayment of 10% instead of the 40% charged for original drugs. However, there are exceptions.

10% copayment for original drugs:

• If no generic is available
• The original drug cannot be replaced by a generic for medical reasons
• The difference in price between the original and generic is less than 30%
  

40% copayment for generics:

• If they are at least 40% more expensive than the average of the cheapest third of all drugs with identical active ingredients
  

Is a generic available for your medicine?

You can use the generic drug finder to find out whether a generic is available for your original drug. The applicable copayment is also shown in the hit list.