OBJECTIVES: Evaluate recent trends of medicine discounting practices in Switzerland

METHODS: We identified and assessed medicines with publicly available and confidential discounts in Switzerland in January 2021 and December 2022.

RESULTS: Switzerland is one of the last countries where most medicines are currently reimbursed at list price or with publicly available discounts. However, to ensure continued access to innovative medicines, the number of confidential discounts agreed upon between the Federal Office of Public Health (FOPH) and manufacturers has greatly increased in recent years. This is done to mitigate the risk of manufacturers avoiding or delaying launches in Switzerland rather than accepting a publicly known reimbursed price. To legitimize this practice, the Swiss federal council adopted amendments to the health insurance act in September 2022.

Therefore, it is expected that the number of medicines with confidential discounts will continue to increase. When comparing the Speciality List (SL) of January 2021 to December 2022, the number of medicines with discounts grew by 181% (from 52 in Q1 2021 to 94 in Q4 2022), while the number of medicines with confidential discounts increased by 267% (from 21 in Q1 2021 to 56 in Q4 2022).

CONCLUSIONS: The rate of negotiated confidential discounts for medicines has drastically increased over the recent years and is expected to continue increasing due to legal clarity surrounding this practice.

In December 2022, the SL showed more medicines with confidential discounts than publicly available discounts. This change in practice offers manufacturers the opportunity to reduce their risk related to international reference pricing, which may make Switzerland more attractive as an early launch country. The FOPH anticipates that this could lead to wider and faster access to medicines at a lower cost.