BERN. A patient in Switzerland who needs a drug the basic insurance does not automatically pay for can receive a yes from one insurer and a no from another, for the same illness. Data the public broadcaster RTS obtained from the Federal Office of Public Health, and published on Monday, put a number on that gap for 2017 to 2019. Among the large insurers, KPT approved 98 per cent of the requests, Assura 96 per cent and Groupe Mutuel 94 per cent. CSS sat at 74 per cent, just under a national average of 76 per cent. Helsana approved 67 per cent, Atupri 53 per cent and Sanitas 45 per cent.
These are case-by-case requests, often called off-label: a medicine used outside the indication, dose or form on its licence, typically for cancer or a rare disease. Basic insurance can pay, but only after the insurer reads the file. The tests are strict. The illness is life-threatening or seriously debilitating, no approved alternative is available, and a substantial benefit is expected. The insurer must consult a trusted doctor and decide a complete application within two weeks. Last year, RTS reported, close to 80,000 such requests were filed.
Why the names were secret for five years
The health office published a study in 2020 that showed large differences and did not name the insurers. RTS asked for the names. The Federal Administrative Court held in February 2024 that the public interest in transparency outweighed the insurers’ private interest. The office then took more than two years to hand the files over. It told RTS the delay was internal, that other work on medicine prices came first, and that the insurers were not the cause. Access was granted on 13 August 2026. The newsroom received a USB stick with about 150 spreadsheets.
The office is refusing a follow-up request for the same kind of data for 2025, at least until it publishes its own evaluation, which it schedules from 2027. Insurers have had to send comparable figures again since 1 January 2024. Households choosing a 2027 policy this month will not have a current league table. They have a table that ends in 2019, and a promise of a newer one after the decision deadline has passed.
What the insurers say the numbers miss
RTS put the figures to each insurer. The umbrella group prio.swiss answered for them: comparing approval rates requires comparable requests and the same definitions, and in the group’s view that is not what these files are. It says a 2024 reform, which makes insurers use a shared assessment tool known as the OLU tool, has dealt with the problem the study described. There is not yet a full public set of figures that tests that claim.
Sanitas, the lowest rate in the table, told RTS that therapeutic trials had been counted as refusals. Count those as favourable decisions, it said, and its rate would be about 80 per cent. The authors of the study disagree. The gaps are too wide to be only a method, and the study still found significant differences among insurers that said they were applying the same rules. Atupri, the insurer RTS said had answered with newer numbers, approved 77 per cent of 1,060 requests in 2024 and 81 per cent of 1,327 in 2025. Without the same count from the others, that is one company’s update, not a ranking.
The deadline that makes an old table urgent
Premiums rise 4.9 per cent in 2027, the fifth increase in a row, and a cancellation that switches basic insurance must arrive by 30 November. Three weeks is a short time in which to learn how an insurer treats the request that is not on the standard list. The honest use of Monday’s table is limited, and it is still the only named comparison the public has. A rate from 2017 to 2019 does not prove what a given file would receive now. It does show that, under the practice the court ordered into the open, the logo on the policy was not a detail.
Anyone switching, or staying, can ask a plain question the statistics cannot answer for a single household: if a specialist requests a drug outside its licence, who decides, how fast, and what share of complete requests that insurer approved last year. The health office will not publish that share, insurer by insurer, before 2027. The switch closes on 30 November. Ask before the letter has to be in.