Second cost containment package in the healthcare sector

In August 2020, the consultation on a second package of measures to contain costs in the healthcare system (CCP 2) was opened. scienceindustries submitted its comments on 19 November 2020. On 7 September 2022, the Federal Council adopted the dispatch on CCP 2 (22.062) for the attention of Parliament. It provides for networks to promote coordinated healthcare and improve the quality of healthcare. The Federal Council also wants to ensure rapid and cost-effective access to innovative medicines.

A more differentiated review of the efficacy, expediency and economic efficiency (EEE criteria) of medicinal products and the introduction of fair reference tariffs to ensure competition between hospitals is also envisaged. Furthermore, pharmacies should be given the opportunity to provide independent services as part of prevention programmes or advisory services to optimise the dispensing of medicines and treatment adherence. Finally, all service providers in the inpatient and outpatient sectors are to be obliged to transmit their invoices in electronic form in future.

Review of the EEE criteria
scienceindustries firmly rejects the prioritisation of cost-effectiveness in the review of the EEE criteria, which is already carried out regularly in the pharmaceutical sector. This would allow the Federal Council to adapt all the rules for the review of cost-effectiveness too easily without involving Parliament. These changes would give the Federal Office of Public Health an arbitrarily wide margin of discretion, which could in fact lead to a principle of cheapest price in the case of annual EEE reviews. The current lack of predictability and legal certainty would be further undermined, which would additionally jeopardise the supply situation for medicinal products. Any amendments to the law in this regard would instead have to be made through a targeted expansion and differentiation of the existing criteria, including consideration of the latest scientific methods for proving the efficacy of medicinal products on the specialities list.

Pricing models
Among other things, the Federal Council wants to ensure rapid and cost-effective access to innovative medicinal products. To this end, the existing practice of agreements with pharmaceutical companies, known as price models, is to be consolidated at the legislative level. When implementing price models, pharmaceutical companies reimburse part of the price or the costs incurred to the insurers. In certain cases, rapid and cost-effective access to vital, high-priced medicines can only be guaranteed if confidential pricing models are implemented. For this reason, the implementation of such models should also be made possible in Switzerland.

In principle, scienceindustries is in favour of the compromise originally negotiated by the National Council on the regulation of pricing models. The aim must be to make new therapies available to patients much more quickly once they have been authorised by Swissmedic. The new regulation raises justified hopes that this concern could be met. In addition, the transparency concerns of the public demanded by certain circles would be satisfied by the report proposed by the National Council on the implementation of the pricing models, which would have to be published regularly by the Federal Office of Public Health.

Status of parliamentary deliberations in summer 2024
In the 2023 autumn session, the National Council adopted CCP 2 largely in line with the majority of its preliminary committee (SGK-N) with regard to the key issues for the supply of medicinal products. In principle, it spoke out in favour of confidential pricing models for medicines that qualify for accelerated approval by Swissmedic. However, this is only subject to the condition that an independent body will regularly report publicly on the implementation of the confidential pricing models. This should make it possible to review the number of these pricing models and their (financial) effectiveness, while individual reimbursements can remain confidential. In addition, it should be possible in future to exempt medicinal products from the periodic review of the EEE if they have a low turnover or if their security of supply is jeopardised. The pharmaceutical industry has largely welcomed these decisions.

However, it is not only the resolutions passed by the Council of States during the summer session that give cause for concern, but also the latest resolutions passed by the SGK-N as part of the resolution of differences on 20/21 June 2024. Both have not only rejected the viable solutions originally adopted by the National Council with the aim of improving access to medical innovation (Art. 52b, c and d of the Health Insurance Act (KVG)), but also completely rejected sensible adjustments with regard to the review of the EEE criteria (Art. 32 para. 3 in conjunction with Art. 52 para. 4 KVG). In addition to the agreed deteriorations, the Council of States also added a further component to the savings package with the cost succession models (Art. 52e KVG) without even consulting on this idea, which is also highly questionable in terms of state policy. Nevertheless, the SGK-N has commissioned the administration to carry out detailed clarifications on the new volume discounts added by the Council of States for high-turnover medicines for further consultations.

scienceindustries regrets the most recent decisions of both the Council of States and the SGK-N on the cost containment package 2. scienceindustries continues to advocate that the National Council adhere to its original decisions, i.e. that it should follow the Commission's minority. The SGK-N currently appears unwilling to comprehensively improve the deteriorating access to innovative medicinal products. It is also failing to send out a signal in favour of greater legal and planning certainty, thereby jeopardising the supply of both innovative and proven medicinal products.