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Old 30.10.2014, 10:16
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Basic health insurance and medicine coverage in pregnancy

Hello,

I hope there is someone who can answer my question .
Does basic health insurance cover the drug Clexane? I have to use it during pregnancy due to a genetic disorder that puts me at risk for developing blood clots in pregnancy which leads to a miscarriage.

Are such drugs covered completely, or do we have to pay 10% or 20% of the cost?

Thank you.
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Old 30.10.2014, 10:46
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Re: Basic health insurance and medicine coverage in pregnancy

AFAIK basic insurance cover all disease/medicine during pregnancy except some prenatal vitamins/magnesium etc. But in any case just send all bills to insurance provider they will either pay you all or write you back the reason why they don't pay for it.

Also note there are some basic insurance policies which requires you to buy medicine from a particular pharmacy only for e.g. "assura pharmed" so check your policy as well before buying medicine.
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Old 30.10.2014, 10:59
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Re: Basic health insurance and medicine coverage in pregnancy

All medicines will have to be prescribed by a doctor, normally your obstetrician. They may choose a different drug- ie the same but with a different name for Switzerland- but if that drug is not on the Swiss approved list, or if for some reason or other they have concern about that drug, and have more experience with another- they may chose to prescribe that- or chose a different sort of treatment. You really need to go and see an obstetrician and discuss this with him or her. But you can't 'impose' a certain drug on a doctor, eg tell them what to prescribe, for instance because you've had it in the past in your country, or because somewone elsewhere has recommended it, be they qualified or not. Good luck- hope all goes well.
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Old 30.10.2014, 11:45
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Re: Basic health insurance and medicine coverage in pregnancy

Clexane is an SL (paid by basic health insurance), schedule B (Rx only, refillable) drug.
http://compendium.ch/search/all/Clexane/startwith/de

But as Odile says, it normally can not be an off label use. Check with a doctor.
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Old 30.10.2014, 12:01
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Re: Basic health insurance and medicine coverage in pregnancy

I presume your doctor suggested you take this particular drug. If it were not covered by insurance, the doctor would have to inform you. You can typically assume that all care is covered by "basic" health insurance unless your are told otherwise.

There is a convenient website that lists all the drugs covered: http://www.spezialitaetenliste.ch/

A fraction of drugs are only covered under specific circumstances - this is called a "limitation". Your doctor is aware of this, they typically make sure the criteria are met and settle the matter with your insurance if questions arise.

Sometimes you are charged 20% of the cost for some original drugs. Typically there is a generic equivalent that only incurs a 10% cost participation. Your doctor/pharmacist will be happy to help you.


Quote:
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Does basic health insurance cover the drug Clexane?
Yes it does.

Quote:
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Are such drugs covered completely, or do we have to pay 10% or 20% of the cost?
Normally, you would be charged the usual 10%. During pregnancy, from the 13th week on, all care is covered completely.

Last edited by vydriduch; 30.10.2014 at 12:02. Reason: Typos
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Old 30.10.2014, 15:32
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Re: Basic health insurance and medicine coverage in pregnancy

Clexane is definitely covered under basic insurance whether for pregnancy or other reasons.
Only available on prescription though but I would assume the OP's doctor has prescribed it in this instance.
As others have said the cost will be covered completely from the 13th week onwards.

We had a friend back in Belgium who had to use clexane in pregnancy for the same reasons as the OP and it became quite challenging to find a suitable injection site towards the end of the pregnancy.
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Old 03.01.2015, 21:30
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Re: Basic health insurance and medicine coverage in pregnancy

Thank you for all the replies. I really appreciate your help.
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Old 29.01.2015, 13:25
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Re: Basic health insurance and medicine coverage in pregnancy

Hi!
I would like to ask how is with basic insurance and if you want to get pregnant? Can Somebody recommend which Insurance company is good and how I should do the "Franchise"?
Thanks, Jana
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Old 29.01.2015, 14:08
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Re: Basic health insurance and medicine coverage in pregnancy

Quote:
View Post
Hi!
I would like to ask how is with basic insurance and if you want to get pregnant? Can Somebody recommend which Insurance company is good and how I should do the "Franchise"?
Thanks, Jana
http://www.englishforum.ch/search2.p...rance+pregnant
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