Medicine rebates: what the SFAO proves, and what stays open
The audit office estimates the volume of possible rebates at up to 743 million Swiss francs a year. That is not proof of damage of the same size.
The debate about medicine rebates does not begin with a number of suspected cases, but with a documented oversight gap. The Swiss Federal Audit Office (SFAO) estimates that the pharmaceutical industry could grant medical practices, pharmacies and hospitals up to 743 million Swiss francs a year in the form of rebates and other pecuniary benefits. That is a lot – but it is not the same as proven damage of the same magnitude.
The decisive distinction is often lost in the political debate. Rebates are not inadmissible per se. They become problematic when they unduly influence prescribing or treatment practice, when they are not correctly declared, or when the pass-through to insurers and insured persons required by law cannot be demonstrated.
What the SFAO actually quantifies
According to the SFAO, spending on medicines in compulsory health insurance amounted to 9.9 billion Swiss francs in 2024. That corresponds to almost a quarter of the costs of that insurance. The SFAO refers to an estimate according to which up to eight percent of this sum – 743 million Swiss francs a year – could flow to service providers as rebates or other pecuniary benefits.
These 743 million Swiss francs are not a determined amount of abuse. They describe a possible scale of rebates. Whether such benefits were passed on in an individual case, to what extent and with what effect cannot be derived from them. Anyone who automatically concludes from the estimate that premium relief of the same size was lost is mixing up volume, legal assessment and damage.
Transparency is prescribed by law
The Health Insurance Act (KVG) in principle obliges service providers to pass on rebates received when purchasing medicines to insurers or insured persons. The Therapeutic Products Act (HMG) supplements this obligation: undue benefits in connection with prescription-only medicines are prohibited. In addition, all rebates must be shown in receipts, invoices and business books and disclosed to the authorities on request.
So there is not only a price rule, but an oversight mandate. Since 2020, the Federal Office of Public Health has been responsible for supervising integrity, transparency and the pass-through of rebates. It must be able to check whether benefits are permissible, whether they influence medical decisions and whether insured persons benefit from the price advantage.
The real question is whether it can be proven
The SFAO's audit report does not focus on the claim that every rebate is unlawful. It shows instead why oversight is demanding: for an authority to check the pass-through, it needs complete and comparable information about purchasing, benefit, billing and use. If this data is missing or not systematically accessible, the statutory obligation remains hard to enforce.
That is also relevant for people who pay premiums. A rebate does not automatically lower costs where it is politically expected. Only once the pass-through is documented and verified can it affect insurers and insured persons under the legal rules. Transparency is therefore not a formality, but the precondition for a verifiable effect on premiums.
No simple answer from a blanket ban
A blanket ban on rebates sounds clear at first glance. But it would not settle every question. Even without rebates, prices, contracts and billing would have to remain verifiable. Conversely, it is not enough to permit allowed exceptions without making their use transparent.
The SFAO's strongest finding is therefore not that a certain number of proceedings proves the scale of the affair. It is this: in a medicine market worth 9.9 billion Swiss francs, the supervisory authority needs enough information to genuinely check the pass-through of rebates. Whether the rules become more effective in future will be decided by this practical ability to supervise – not by a single, spectacular-sounding number.
Sources
- Swiss Federal Audit Office: “Rebates in the dispensing of medicines”
- Federal Office of Public Health: pass-through of rebates
- Fedlex: Health Insurance Act (KVG)
