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Are medicines covered?

Yes, those on the FOPH’s official list. But watch one expensive rule: refusing a generic quadruples your share.

The specialities list

Basic insurance reimburses only medicines entered on the specialities list, maintained by the Federal Office of Public Health. That list also sets their maximum price: a pharmacy may not charge you more.

A medicine off the list is not reimbursed by basic insurance, even on prescription. Some supplementary policies cover part of it, and exceptional cover remains possible for a serious case with no alternative — it is requested from the insurer, with your doctor’s support, and before treatment begins.

The generic rule: 10 or 40 per cent

Where a generic exists, the ordinary 10 per cent co-payment applies only if you take it. If you prefer the original while a generic is available, your co-payment rises to 40 per cent.

The exception is medical, not a matter of preference: if your doctor certifies a medical reason — an intolerance to an excipient, for instance — they note it on the prescription and you stay at 10 per cent. Without that note the surcharge is yours, and on long-term treatment it becomes considerable.

  • Generic: 10 per cent co-payment.
  • Original while a generic exists: 40 per cent co-payment.
  • Original with a certified medical reason: 10 per cent co-payment.

What to ask at the pharmacy

Ask every time: “is there a generic?”. The pharmacist may substitute unless the doctor has said otherwise, but does not always do so unprompted.

And keep your statements: it is on re-reading them that you spot a 40 per cent co-payment you could have avoided.

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