Switzerland’s Journey to Introducing Confidential Managed-Entry Agreements

Country: SWITZERLAND | Region: EUROPE | Type: Policy


PRICENTRIC BRIEF:
  • Switzerland’s Ministry of the Interior has introduced a new law, dubbed “Modèles de Prix Pour Médicaments”, which aims to establish a legal basis for the use of confidential market-access schemes to improve patient access to innovative medicines
  • It is also introducing cost-containment measures for the compulsory health insurance scheme (AOS), dictating, for example, to what extent health costs may increase for inpatient hospital care, outpatient medical treatment, etc
  • However, the creation of a flat-rate payment system has experienced its obstacles, such as the Swiss National Council voting against the nationwide tariff structure, choosing not to implement outpatient

THE DETAILS

BERN, Switzerland – Switzerland’s Ministry of the Interior has introduced a new law, dubbed “Modèles de Prix Pour Médicaments”, which aims to establish a legal basis for the use of confidential market-access schemes to improve patient access to innovative medicines.

The law, which was announced on August 19th, provides a confidentiality clause for the price of medicines when it comes to managed entry agreements, which would no longer make public the refund for a drug, especially in instances where the discount is high.

The rule could apply to newly implemented pricing models in Switzerland:

Pricing ModelImplementation
Return according to priceReturn part of the price
Volume limitationTotal or partial refund of costs when they exceed a certain volume of turnover or a certain duration of therapy
Pay for performanceReimbursement of costs if therapy is interrupted due to lack of effect or side effects

Last year 20 such confidential managed entry deals were negotiated in Switzerland. In the past, Switzerland has published price discounts but is heading in a new direction following the rise in rebate negotiations – the aforementioned 20 deals – with pharmaceutical companies in Switzerland.

Switzerland’s new pricing models for drugs aim to guarantee “rapid and most advantageous access” to innovative and expensive medicines. So far, the Federal Council has approved a collective agreement with the industry association of Swiss health insurers (Santésuisse) and the national umbrella association of public and private Swiss hospitals (H + Die Spitäler der Schweiz) on the remuneration of innovative cancer treatment that allows the compulsory health service (OKP) to pay for costly cancer therapies, in particular cell and gene therapies such as CAR T-cell therapy, at a reduced, confidential price.

The agreement, which entails expediting access to these treatments, is limited to until December 31, 2021, according to Switzerland’s Federal Office of Public Health (FOPH).

For stakeholders, CAR T-cell therapy is viewed less as a drug and more so a “medical service,” which requires stricter arrangements for administration and remuneration, among other things.

With the conclusion of this agreement, Switzerland is finalizing a flat-rate payment system for outpatient services; 75 such payments have been fleshed out so far and have been submitted to the Federal Council for approval.

The moves are all part of an effort to combat rising health insurance premiums in Switzerland, following a report that premiums have doubled over the course of the past 20 years, forcing a number of Swiss households to spend nearly one fifth of their salary on healthcare expenses.

Expenses have swelled by 120% on average since the year 2000, as told by figures from the Swiss Trade Union.

CRITICISM

On the announcement, Adrian Lobsiger, Federal Commissioner for Data Protection and Information wrote a letter criticizing confidentiality when it comes to the price of medicines because the clause contradicts principles of public access, particularly to medicine prices.

Lobsiger believes it is essential for the public to have access to the price approval procedure; in fact, Switzerland has always been an advocate of price transparency.

The information on the discounts applied to prices so far is available here. But, according to critics like Lobsiger, the website is difficult to navigate, the discount price almost impossible to find and calculate.

THE FUTURE

On a positive note, the decision to fund these innovative treatments to improve access while ensuring cost-containment raised further questions regarding payments and cost-containment in Switzerland, and as such, the CAR-T agreement opened up further conversation about outpatient flat-rates and nation-wide tariff structures.

However, thus far, the Swiss National Council voted against a nationwide tariff structure, choosing not to implement outpatient flat rates across the board.

Following the setback, Santésuisse declared that it is now up to the National Council to hold on to the outpatient flat rates in order to find a way out of the “tariff impasse” that Switzerland is facing, noting that the Council’s voting will make the journey more difficult.

The scope of these pricing models includes other measures such as differentiated examination of efficacy, adequacy, and economic analyses of drugs, and the introduction of fair benchmarks to ensure competition between hospitals.

As Switzerland relies on prices found in nine other countries to calculate the prices of medicines, it wants to make sure it gets the best deal. Which is not always an easy task, seeing as elsewhere countries have signed discount agreements that aren’t always published. With these payment schemes, as mentioned, Switzerland aims to increase access to innovation.

COST-CONTAINMENT

In another effort to combat rising health insurance premiums, Switzerland is introducing cost-containment measures for the compulsory health insurance scheme (AOS), dictating, for example, to what extent health costs may increase for inpatient hospital care, outpatient medical treatment, etc. All in all, Switzerland is implementing the changes with hopes to reap potential savings of nearly a billion francs, or 3% on the amount of premiums.

Outpatient services will always be remunerated in the same way (flat-rates) for all 70-plus procedures. However, according to Santésuisse, if further development shows that there are large differences in effort for certain patient groups, the structure can and should be refined.

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