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The federal health office that decides which medicines Swiss basic insurance pays for, and at what price, by listing them on the Spezialitätenliste. A cancer drug can be approved by Swissmedic and still not be paid for until it is listed.
Under the Health Insurance Act (KVG) every service the compulsory basic insurance pays for must be effective, appropriate and economical, the WZW criteria of Article 32. For medicines the BAG applies them by listing a product on the Spezialitätenliste (SL), advised by the Federal Drugs Commission (Eidgenössische Arzneimittelkommission, KVV Article 37e). A product needs a valid Swissmedic authorisation (KVV Article 65), and its economic price is set half from a therapeutic cross-comparison with drugs for the same disease and half from the average price in nine reference countries: Belgium, Denmark, Germany, Finland, France, the United Kingdom, the Netherlands, Austria and Sweden (KVV Article 65b, KLV Article 34abis). The ordinances do not use a cost-per-QALY threshold.
A company may file with the BAG once Swissmedic has confirmed the indication and dose in its preliminary decision, and where it does, KLV Article 31b says the BAG decides as a rule within 60 days of final authorisation. The industry association Interpharma calculated that in 2025 this happened for 4 per cent of newly authorised medicines and that the median time from authorisation to SL listing was 219 days; that is an industry calculation from SL and Swissmedic data, not a BAG figure, and OnCo could not find the BAG's own measure.
Before a drug is listed, or for a use outside its label, insurers can pay case by case under KVV Articles 71a to 71d, after consulting their medical adviser, where a large therapeutic benefit is expected against a disease that can be fatal or cause severe chronic harm and there is no effective authorised alternative. The insurer must decide within two weeks of a complete request and must give reasons for a refusal to doctor and patient; the price is negotiated with the company at a discount of up to 50 per cent on the reference price, depending on the benefit category.
Shares Regulatory divergence between regions, Prices and value.
Shares Regulatory divergence between regions, Prices and value.
Shares Regulatory divergence between regions, Prices and value.
Shares Regulatory divergence between regions, Prices and value.
Shares Regulatory divergence between regions, Prices and value.
Shares Regulatory divergence between regions, Prices and value.
Shares Regulatory divergence between regions, Prices and value.
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