Exceptional access to drugs in Switzerland: a front-line pharmacy’s perspective

Switzerland’s healthcare system is complex, involving a regulated interplay among the federal, cantonal, and local governments. Swiss federalism classically gives power to the cantons, except in areas where the Constitution confers powers to the Confederation. In healthcare, the powers conferred to the Confederation are essentially of a legislative nature, and relate to the regulation of financing, quality and safety of medicines, certain areas of public health, as well as research and development [1]. Outpatient care is mainly provided by the private sector and is essentially based on a liberal system. Most healthcare professionals, including pharmacists, work independently in private care structures. This dynamic interplay between the public and private sectors, along with split responsibilities, significantly influences the system, resulting in a decentralized and fragmented healthcare framework [2]. This fragmentation extends to medicine reimbursement policies, which are regulated under the Federal Law on Compulsory Health Care (LAMal in French). Outpatient services are covered by the compulsory health insurance mandated for all residents of Switzerland, obtained from private health insurance providers [3]. The reimbursement and prices of prescribed medicines are strictly regulated by the Federal Office of Public Health (FOPH), which evaluates whether the medicinal product meets the criteria of effectiveness, appropriateness, and cost-effectiveness before including it on the “List of Pharmaceutical Specialties” (LS). Medicines are either reimbursed if included in the LS or not, with no partial reimbursement. Furthermore, reimbursement may be limited to specific conditions, e.g. based on the clinical situation or the patient’s characteristics. In principle, reimbursement is restricted to indications and conditions of use approved by Swissmedic, the Swiss agency for therapeutic products.