Switzerland

In June 2020, santésuisse (the leading organization of Swiss health insurers) and the Swiss Society of Surgeons (FCMH) have submitted a proposal to the Federal Council for the acceptance of 67 lump-sum payment packages for out-patient services. In July 2020, eight more lump-sum payment packages were suggested to the Federal Council. More suggestions are expected in the near future.

On 22nd June 2020, the company in charge of the development of the DRG system in Switzerland, SwissDRG SA, has announced the catalog version of SwissDRG 10.0/2021 (2018/2021). Seven days later, the planning version of SwissDRG (2019/2021) has been published as well.

On June 23, 2020, the Swiss Federal Office of Public Health (FOPH) announced several changes in the coverage of benefits that will take place soon. They regard transcatheter aortic valve implantation (TAVI), adjustments in the List of Aids (EMAp/MiGeL) (including reimbursement for CPAP devices and mechanical ventilation at home, and adjustments in the List of Analyses (AL/EA).

The Swiss cantons are required to jointly draw up a plan for the provision of highly specialized medical treatments (MHS). Until September 2020, the Conference of Cantonal Health Directors is discussing whether complex gynecological tumors, pediatric oncology, bariatric surgery, highly specialized pediatric surgery, and other areas of care should enter the MHS.

On May 27, 2020, the Federal Council adopted the modification of the Insurance Law (KVG/LAMal) on the reimbursement of medical aids and equipment. In the future, health insurers will have to bear the costs of the medical material regardless of whether it is used directly by the insured person, by a non-professional person, or by the nursing staff.

In March 2020, the entity managing the Swiss DRG system, SwissDRG, released several announcements about the changes related to the COVID19. The announcements concern diagnosis coding of COVID19, and the reimbursement changes required to adequately cover the care for the new disease.

On March 4, 2020, the List of Analyses (AL/EA) and the Services Ordinance (KLV/OPre) were updated in Switzerland. On April 1, 2020, the KLV/OPre, the AL/EA, and the List of Medical Aids (MiGel/EMAp) will be updated in Switzerland.

On February 12, 2020, it was announced that the Swiss Federal Council is planning to modify the Health Insurance Ordinance (OAMal / KVV) with the goal of enhancing hospital planning, and unification of the inpatient tariffs throughout the country.

On January 31, 2020, the non-statutory HTA body, Swiss Medical Board, published the results of the report in which they compared the surgical and non-surgical treatment of rotator cuff tears. Though the surgery is more effective, the traditional treatment demonstrated better cost-benefit results. Thus, the Swiss Medical Board recommends the rotator cuff surgery with limitations.

At the end of January 2020, the entity managing the DRG system in Switzerland, SwissDRG, has published the data collection forms for SwissDRG 2020 (2019 data). Furthermore, an explanation about the coding of “Aortic stent graft (stent prosthesis)” has been released.

We have released the interview on the Market Access Insider channel on Youtube. The interview covered key stakeholders, procedure coding, functioning of the DRG system, reimbursement processes for medical technologies in Switzerland. Michel discussed the biggest mistakes made by the Med Tech companies on the market and advised on the best strategy on how to approach the market.

The Swiss Services Ordinance (KLV/OPre) is the document that defines the health care services which are covered by the compulsory health insurance in Switzerland. It is updated annually (with more frequent updates possible); thus, the 2020 version is released. Changes concern autologous transplantation of chondrocytes, extracorporeal photopheresis, transcatheter aortic valve implantation, ultrasound therapy focused on the pallidum, thalamus and subthalamus, CAR-T cell therapies, tomography with positron emission (PET/CT), stereotactic radiation therapy (photons) of wet age-related macular degeneration.