Dossiers - Reforms in the healthcare sector
Overview and position on cost containment packages
The chemical, pharmaceutical and life sciences industries have an interest in maintaining a sound and stable healthcare system, which is why scienceindustries is actively involved in the process of implementing the cost containment programme.
In August 2019, the Federal Council approved a first cost-containment programme for the attention of parliament. It requires all role players in the healthcare sector to ensure that costs only increase to the extent that can be medically justified. The discussion of this first package of measures was split into two sub-packages (sub-packages 1a and 1b). While our industry has primarily followed the debate on the experimentation article in package 1a, package 1b contains three proposals: measures to manage costs by the tariff partners, a reference price system for medicinal products and a right for health insurance companies to appeal cantonal hospital planning.
Cost containment package 1
Discussion of sub-package 1a was concluded by the chambers during the 2021 summer session. Industry noted with relief that - in contrast to the Federal Council - both chambers did not want to introduce any compulsory obligation in the context of the experimentation article. The new experimentation article has not yet been put into effect by the Federal Council. When it is applied, it will be important to ensure that it does not water down the principle of territoriality.
Following lengthy deliberations, the Swiss parliament adopted CCP 1b in the autumn session of 2022. This now provides for cost monitoring in the healthcare sector. However, the Confederation and the cantons should not be allowed to intervene if the collective bargaining partners are unable to reach an agreement. Fortunately, parliament already abolished the reference price system for generics in the first round of consultations, but the approval of parallel-imported drugs is now being simplified.
scienceindustries is relieved about the fact that the original decision of the National Council to bypass Swissmedic for imports of medicinal products has been dropped, as this would have caused serious uncertainties regarding the supply of medicinal products in Switzerland. In addition, the two parliamentary chambers have agreed on a right of appeal for health insurance associations against hospital planning decisions in the cantons. The regulation on the right of substitution for pharmacists has also been amended.
Cost containment package 2
The consultation process for the second package of measures (CCP 2) started in August 2020 and scienceindustries submitted its opinion on 19 November 2020. In parallel to this package, the proposed introduction of targets in the healthcare sector in the form of counterproposals by the Federal Council to the Mitte party’s Cost-Brake Initiative and the Social Democratic Party’s (SP) Premium-Relief Initiative were sent to parliamentary debate.
scienceindustries rejects the proposed targets, in particular in combination with an obligation to contact an initial consultation centre. This could lead to the rationing of healthcare services and will in the end prevent innovation.
In this regard, the Social Commission of the Council of States (SGK-S) asked its chamber to extend the processing period for both topics by one year. The Council of States followed this recommendation and did not approve the 30% increase in the federal share of the premium reduction during the autumn session 2022. Rather, the detailed consultation on the indirect counterproposals will now be continued by the SGK-S.
On 7 September 2022, the Federal Council submitted the dispatch on CCP 2 for consideration by parliament. It proposes networks to promote coordinated healthcare and improve the quality of healthcare. The Federal Council also wants to ensure rapid access that is as cost-effective as possible to innovative, expensive medicines. To this end, the existing practice of agreements with pharmaceutical companies, known as price models, should be entrenched in legislation.
Pharmaceutical companies refund part of the price or costs incurred to insurers when implementing price models. In certain cases, rapid and cost-effective access to essential high-priced medicines can only be ensured through the implementation of confidential price models. This is why confidential price models should also be allowed in Switzerland.
Provision is also made for a more differentiated assessment of the efficacy, expediency and economic efficiency, among other things, of medicinal products and the introduction of fair reference tariffs to ensure competition among hospitals. Pharmacies should also be given the opportunity to provide independent services as part of prevention programmes or consultancy services to optimise drug delivery and treatment adherence. Finally, all providers of inpatient and outpatient services should be obliged to send their invoices electronically in future.
scienceindustries is generally in favour of the proposed regulation of price models as this can improve patients' access to innovative medicinal products. The objective must be to make new treatments available to patients more rapidly after their approval by Swissmedic. However, scienceindustries categorically rejects giving precedence to the cost effectiveness of all services when doing the regular review of the efficacy, expediency and economic efficiency (EEE) criteria.
This would allow the Federal Council to amend all the rules for the EEE review without the participation of Parliament and introduce the cheapest principle together with an annual EEE review through the back door, which would seriously erode predictability and legal certainty. Any such changes to the law must by made by way of the targeted expansion and differentiation of the current criteria, including consideration of the latest scientific methods to prove the effectiveness of medicinal products for the Specialty List.
Revision of the health insurance ordinances
It should also be mentioned in this context that a revision of the Health Insurance Ordinance (KVV) and the Health Care Benefits Ordinance (KLV) has recently been initiated. scienceindustries firmly rejects the proposed amendments and returns the proposal for reconsideration.
There is also a significant link between CCP 2 and this revision of the health insurance ordinances. A coordinated approach to both matters is of key importance, which is why discussions on CCP 2 must first be conducted and concluded in parliament before the corresponding ordinances can be amended. We asked both the Federal Council and the SGK-N to take this into account and to proceed accordingly.
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