Second Cost Containment Package Adopted

With the second cost containment package adopted by the Swiss Parliament in the 2025 spring session, significant changes to the healthcare system are imminent. From the perspective of the pharmaceutical industry, the adopted legislation is sobering: once again, the majority of cost-containment measures are being borne by the pharmaceutical sector. The breaking point has now been reached. In order to ensure a reliable supply of innovative and established medicines in Switzerland, no further cost-cutting measures must be adopted at the expense of the industry, and patient access must be improved.

In August 2020, the consultation process for a second package of healthcare cost-containment measures (CCP2) was launched. scienceindustries submitted its position (in German) on 19 November 2020. On 7 September 2022, the Federal Council presented its message on CCP2 (22.062) to Parliament. The proposal included networks to promote coordinated care and improve the quality of care. The Federal Council also intended to ensure rapid and cost-effective access to innovative medicines.

A more differentiated assessment of the effectiveness, appropriateness and economic efficiency (EAE) of medicines, among other things, was also planned, as was the introduction of fair reference tariffs to ensure competition among hospitals.

Review of the EAE criteria

scienceindustries firmly rejects giving cost-effectiveness priority in the current, already frequent EAE reviews of medicines. The Federal Council would be able to unilaterally amend the rules governing the evaluation of these criteria without involving Parliament. These changes would give the Federal Office of Public Health (FOPH) arbitrarily broad discretionary powers, which could effectively lead to a lowest-price principle in EAE reviews, which may even be carried out annually. Legal certainty and planning reliability, which are already lacking, would be further undermined – ultimately jeopardising the supply of medicinal products.

The Federal Council can now differentiate the frequency of individual criteria depending on the type of service as part of the EAE review. It will also be able to review individual criteria in isolation in future. This gives it expanded powers with potentially far-reaching implications. How the new regulation is implemented in practice will therefore be crucial. scienceindustries calls for clear guidelines and transparent practical application to ensure that security of supply, innovation and medical progress do not come under further pressure.

Making Sensible Use of Pricing Models – Without New Barriers 

Among other things, the Federal Council wants to ensure rapid and cost-effective access to innovative medicines. To this end, the existing practice of agreements with pharmaceutical companies, known as price models, is to be enshrined in law. Under these models, pharmaceutical companies reimburse insurers for part of the price or the costs incurred. In certain cases, rapid and cost-effective access to life-saving, high-priced medicines can only be guaranteed if confidential price models are implemented. For this reason, the implementation of such models is now also to be made possible in Switzerland.

The introduction of confidential pricing models has been approved by Parliament. In future, the Federal Council will be able to stipulate that information on the amount, calculation or modalities of reimbursements does not have to be published – not even under the Federal Act on Freedom of Information in the Administration (FoIA) or corresponding cantonal regulations. This option meets an important concern of the industry.  

The decisive factor will now be how the implementation is shaped in concrete terms. Clear processes, efficient negotiations and reliable handling by the authorities are needed to ensure that the desired acceleration of patient access is actually achieved. Price models can only be effective if they do not lead to additional complexity or delays. scienceindustries expects the Federal Council and the FOPH to make determined use of the potential of these instruments without creating new bureaucratic hurdles, thereby contributing to a sustainable improvement in the supply of innovative medicines.

Approved Cost Consequence Models Are Painful  

With the newly introduced Art. 52e of the Health Insurance Act (HIA), a legal basis has been established for volume-based rebates on high-turnover medicines. Despite criticism from the industry, the provision was adopted. At least product-specific factors such as the number of indications or the availability of active substances could be taken into account in the parliamentary process. It remains to be seen whether the regulations will actually implement this differentiated approach.

A new article in the Swiss Federal Law on Health Insurance (KVG) allows, under certain conditions, provisional reimbursement of medicinal products from the date of their Swissmedic authorisation. This could speed up access to innovative medicines, provided that the demanding requirements can be met in practice.

Supply Risks Remain  

With the second cost containment package, almost all savings in the healthcare system were achieved through measures in the area of pharmaceuticals. The pharmaceutical industry is thus once again making a significant contribution to containing healthcare costs – for example, through the introduction of cost impact models, which are expected to generate substantial savings. At the same time, many measures originally planned that would have affected other areas of healthcare were deleted or watered down during the parliamentary process.

From the industry's point of view, the overall impact of the package remains unbalanced: while the contribution to cost reduction is clearly at the expense of research-based companies, the improvements in patient access to innovative medicines provided for in the law have not yet been sufficiently specified. According to industry observations, access to innovative therapies is continuing to deteriorate, which is putting pressure on the security of supply.

The industry is therefore calling for the implementation of the legislative changes at the ordinance level to be carried out with a sense of proportion. In particular, the application of cost impact models should be differentiated and take product-specific characteristics into account. Furthermore, the announced modernisation of the pricing system is crucial to ensure rapid access to innovative therapies and to guarantee the attractiveness of the location and security of supply in the long term.