Reimbursement Landscape in Switzerland
The purpose of this step is to understand the current reimbursement environment in Switzerland, relevant for your medical device. To do so, we will:
- Clarify the relevant type of coding systems, such as the hospital procedure code system (Schweizerischer Operationen und Prozeduren, CHOP), the Swiss Medical Tariff (Tarif Médicaux, TARMED), the Medical Aid and Device List (Mittel- und Gegenstände-Liste, MiGeL) or the SwissDRG system. Identify relevant coverage policies, under the public basic package insurance plan and supplementary private insurance. Indicate the assigned payment rates in different reimbursement catalogs, applicable for the specific device or to any comparable products.
- Locate any specific reimbursement mechanisms that could be utilized by the device, as-is, or recommend on whether new mechanisms will have to be developed and if so, which mechanisms (e.g., an application for an adjustment to the TARMED / SwissDRG system or an application for inclusion in separated positive lists, such as the Analytes List (Analysenliste) in the case of lab tests.
- Identify the main decision makers, lay out the typical path towards obtaining reimbursement under the public basic package plan and supplementary private insurance, including milestones and typical timelines and provide an initial reimbursement strategy for the device in Switzerland.
Reimbursement Planning for Swiss Decision Makers
According to the conclusions in the Reimbursement Landscape, we devise the plan for developing the required evidence for Swiss decision makers, such as the umbrella organization of health insurers (Santésuisse), the Federal Office of Public Health (Bundesamt für Gesundheit, BAG), the Federal Social Insurance Office (Bundesamt für Sozialversicherungen, BSV) or the Swiss medical association (FMH). This includes the development of:
- Value Story: Puts forward the claims for clinical and economic benefits associated with the use of the new device in the eyes of the relevant decision makers (healthcare providers, Swiss health insurance companies) and would serve as the basis for the Economic Model.
- Economic Model: Highlights the economic benefits of the new device from the perspective of Swiss decision makers. May identify specific outcomes data that should be added to future clinical study protocols.
- Clinical Data: Recommendations for adjustments and modifications of any planned clinical studies in order to generate the required reimbursement-related evidence for decision makers.
- Decision Makers' Feedback: Conduct interviews with the identified Swiss decision makers, utilizing Mediclever's network of local clinicians, payer representatives and other stakeholders in Switzerland, to obtain their feedback regarding the developed value story, the economic model and the reimbursement aspects of the planned clinical study.
Implementation
Depending upon the existence, or the lack of, applicable reimbursement mechanisms (as identified in the Reimbursement Landscape step), we will conduct the following activities:
- Billing Guide: Develop a set of instructions guiding physicians and other healthcare providers how to obtain reimbursement following the use of the new device.
- Reimbursement Applications: Work with the relevant medical societies to apply for new reimbursement mechanisms, such as an application for an adjustment to the TARMED / SwissDRG system, an application for inclusion in the Medical Aid and Device List (MiGeL) or an application for inclusion in separated positive lists.
- Pilot Projects: Collaborate with healthcare providers and insurers to apply to any of the 23 cantons in request for pilot projects.
- Other Funding Options: Collaborate with physicians and offer access program that encourage healthcare providers to seek reimbursement for their patients on a case-by-case basis.
