Coverage of medicine and pharmacy expenses

Third-party payer or third-party guarantor?

There are two systems for the reimbursement of pharmacy costs: the third-party guarantor system and the third-party payer system.

The third-party guarantor system is the default system provided by the Federal Law on Health Insurance (LAMal/KVG): the insured person pays for his or her medication at the pharmacy and is reimbursed by the health insurance once the annual deductible has been reached.

Within the third-party payer system, the health insurance company receives medication invoices directly and pays them. The policyholder then pays the deductible and his or her share of the costs.

The member health insurers of Groupe Mutuel operate according to the third-party payer system.

Drugs covered by basic health insurance

The drugs covered by compulsory health insurance are listed on the specialty drugs list (LS/SL) and the list of medicines with tariff (LMT/ALT).

• The specialty drugs list is compiled and maintained by the Federal Office of Public Health (FOPH). It lists the drugs authorised by swissmedic that are effective, appropriate and economical. The list is available here: specialty drugs list (LS/SL).
• The list of medicines with tariff (LMT/ALT) lists the products and active components used in pharmaceutical preparations manufactured by pharmacists.

Basic health insurance covers only the drugs that are on the LS/SL or LMT/ALT lists and have been prescribed by a doctor.

Drugs not covered by health insurance

Drugs on the list of pharmaceutical products for special application (LPPA/LPPV) are not reimbursed by compulsory health insurance or by a supplemental insurance plan. The LPPA/LPPV list is available here: List of pharmaceutical products for special application (LPPA/LPPV).

Please note that some products or groups of products are not listed by name in the LPPA/LPPV list. This concerns mainly products that serve to improve general well-being such as food supplements, cosmetics, dietary products, etc.

“Non-reimbursable” drugs: covered by supplemental insurance

“Non-reimbursable” drugs are preparations that are authorised for sale in Switzerland by swissmedic, but are not listed in the LS/SL or LPPA/LPPV lists. These drugs can be reimbursed by a supplemental insurance plan upon medical prescription only.
Discover our supplemental insurance plans that cover drugs not reimbursed under basic health insurance and prescribed by your doctor.