Updates in the coverage of medical services in Switzerland since July 2023

On June 19, 2023, the Swiss Federal Office of Public Health (FOPH) published the changes that will occur to the Healthcare Benefit Ordinance (KLV/OPre) and its Annexes, which determines coverage of medical services in Switzerland.

The most important examples of updates occurring to Annex 1 of the Healthcare Benefit Ordinance (explicitly evaluated services with coverage decisions) are listed below:

• Reimbursement conditions for transcatheter aortic valve implantation (TAVI) have been revised and are now clearly defined;
• The reimbursement conditions for dual-energy x-ray absorptiometry (DEXA) are extended with the ability to conduct the procedure during anticonvulsant therapy;
• The reimbursement for autologous fat grafting for postoperative breast reconstruction is extended till December 31, 2023 (Coverage with Evidence Development);

Regarding Annex 2 of the Healthcare Benefit Ordinance (List of Means and Devices) there are many changes in reimbursement conditions tariffs and of medical aids. In addition, the following reimbursement categories were added:

• 25.03 " Films for glasses”;
• 35.15 “Conventional wound preparations with and without additional antimicrobial active substances”;
• 35.25.02 “Auxiliaries in the form of silk underwear with the covalently bound antimicrobial function”.

Finally, two more reimbursement codes were added in Annex 3 of the Services Ordinance (List of analyses):

• Code 3565.00, Bacterial DNA (16S rRNA gene): amplification of DNA, including the amplifier determination, with the tariff of 119.7 CHF;
• Code 3566.00, Bacterial DNA (16S rRNA gene): amplification of DNA, including the amplifier determination, sequencing, and analysis, with the tariff of 262.8 CHF.

The updates will enter into force on July 1. 2023. More details can be found in German here.

This news is just one of about 300 market access news collected by our team in the subscription services "HTA Alerts" and "Reimbursement Alerts" every two weeks from more than 80 organizations. Access our paid subscription services to stay on top of all developments specifically for your products in Europe (reimbursement news) and globally (HTA news). Contact us to get a free, three-month, no-obligation trial.