Costs covered by health insurance

for medicines

Medicines: Costs covered

Antibiotics, painkillers and cough syrup: Basic insurance covers the cost of many medicines, but not all.

Basic insurance

Certain criteria must be met for the costs of prescription medicines to be covered.

Supplementary insurance

Covers 80% of the costs of medicines that are not covered by basic insurance, for example  alternative medical remedies. 

Save money with generics

You only pay a copayment of 10% if you opt for a generic drug. 

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Cost share for medicines

A medicine must fulfil certain requirements in order to be covered by basic and supplementary insurance.

  • What costs are covered under basic insurance?

    For basic insurance to cover the costs of a medicine, it must be prescribed by a doctor. In addition, the medicine must 

    You pay a share of the costs for medicines through your deductible and copayment. The copayment for original drugs is usually 40%, for generics usually 10%.

  • What costs are covered by supplementary insurance?

    Our supplementary insurance plans cover additional costs for medically prescribed medicines that are not covered by basic insurance: 

    * The Jump, Classic and Family supplementary insurance plans can no longer be taken out. Existing customers continue to enjoy the usual benefits.

    Conditions for cost coverage:

    • The medicine must be registered with Swissmedic for the treatment of the disease. 
    • The medicine must not be on the List of uninsured drugs and products.
    • Supplementary insurance covers other alternative medical remedies. For this purpose, a doctor or a natural health practitioner recognised by Sanitas must dispense or prescribe the remedies.

     

     

  • Save money with generics

    Generics contain the identical active ingredients in the same dosage as the original preparations, but usually cost less. In addition, your copayment is usually lower under basic insurance if you opt for a generic drug. You get twice the benefits:

    Generics: 10% copayment

    Exception: You pay a copayment of 40% for a generic if the ex-factory price exceeds a certain limit. The doctor or pharmacist will inform the insured person if a medicine has an increased copayment.

    Original drugs: 40% copayment

    Exception: You only pay a copayment of 10% for original drugs if 

    • no generic drug is available,
    • the original drug cannot be replaced by a generic for medical reasons, or
    • the price difference between the original and the generic is less than 20%. 

    Why do generics cost less?

    As soon as a particular medication’s patent protection has expired, it may be copied. As a result, the development costs and therefore the price of generics are lower.
Is a low-cost generic available for my medicine?

Downloads

  • List of uninsured drugs and products