Swiss audit office says drug discounts rarely reach patients

Only a small share of discounts on prescription medicines reaches patients, according to the Swiss Federal Audit Office. Doctors, pharmacists and hospital managers retain much of the money, SRF reported on Thursday.

Under the Health Insurance Act, discounts obtained when buying medicines must be passed on to patients through health insurers. Under certain conditions, or through an agreement with the federal government, healthcare providers may retain part of the discounts for quality improvements, training, research or advertising.

The Federal Audit Office said the government lacks reliable data and cannot monitor the system effectively. Existing figures come from older studies and from doctors’ practices and hospitals that have agreements with the government. Those agreements cover only 24 percent of hospitals and 16 percent of doctors who dispense medicines.

The audit office estimated that discounts totalled about 740 million Swiss francs in 2024. Insured people received 88 million francs, or roughly 12 percent, while doctors, pharmacists and hospitals retained the remaining 655 million francs. The audit office estimates that the sector should have passed on about half of that amount.

The audit office criticised the Federal Office of Public Health for carrying out too few checks and for failing to focus sufficiently on risks. It recommended collecting better data and extending controls to pharmacies and wholesalers. It said those who provide no information face a greater risk of retaining discounts improperly and violating the law.

The Federal Office of Public Health initially told the audit office that health insurers were responsible for leading the controls and that it lacked the legal basis and resources for comprehensive data collection and inspections. After the audit office involved Federal Councillor Elisabeth Baume-Schneider, the office agreed to devote more resources to the issue. Regulations are to be amended, and areas for joint inspections with health insurers are to be defined.

The Medicines Act also requires transparency and prohibits the acceptance of improper benefits connected with prescription medicines. Pharmaceutical companies may, for example, make advertising payments to doctors or pharmacists. But the audit office and the Federal Office of Public Health consider estimated payments of about 50 million francs each in 2024 to be excessive.

The Federal Office of Public Health can order discounts to be passed on and impose sanctions for violations. The audit office said neither measure had yet been used. The office confirmed that six proceedings are pending, including one against a pharmaceutical company over high advertising payments to a doctor’s practice.