Updates in the coverage of medical services in Switzerland in 2026

On December 3, 2025, the Swiss Federal Office of Public Health published the changes that will occur to the Healthcare Benefit Ordinance (KLV/OPre), which determines coverage of medical services in Switzerland. The updates will enter into force on January 1, 2026, and include the following:

• Changes in KLV relating to prophylactic vaccinations, cost containment measures, nursing care, educational requirements for laboratory heads, and other matters.
• Changes in Annex 1 KLV (List of explicitly evaluated services):
  • Definitive coverage is granted to several technologies previously falling under the Coverage with Evidence Development scheme, including transcatheter aortic valve implantation in low-risk patients and extracorporeal photopheresis for the treatment of bronchiolitis obliterans after lung transplantation;
  • Coverage with Evidence Development is extended for several technologies, including autologous chondrocyte transplantation for the treatment of post-traumatic cartilage lesions of the knee joint and multigene expression test in breast cancer.
• Changes in Annex 1a KLV (outpatient-before-inpatient mandate):
  • The modifications concern the expansion of the outpatient mandate to several new procedures on the foot and elbow, as well as the update of clinical and social criteria that justify exceptions for inpatient admission.
• Changes in Annex 2 of the Healthcare Benefit Ordinance (List of Medical Aids, MiGeL):
  • Staged changes are expected in the reimbursement of various medical aids, including glucose monitoring systems (effective January 1, 2026), digital devices (effective June 1, 2026), and artificial nutrition (effective January 1, 2027).
• Changes in Annex 3 of the Healthcare Benefit Ordinance (List of Analyses, AL):
  • The modifications include minor adjustments and the introduction of a new code 3489.00 "Dermatophytes" (nucleic acid amplification) with a tariff of 119.7 CHF.

See the details in German here, here, here, here, and here.

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