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Old 08.06.2008, 00:14
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Cost of Medication with and without prescription

Hello, everyone,

I wonder if anyone has come across the following situation I was in today.

My son had a chicken pox and the doctor prescribed some white mixture medicine for the spots, which we've bought in the local pharmacy. They mixed it in the pharmacy and charged 17 CHF. We have run out of that mixture quickly so I went to another pharmacy and bought another 100 ml for 11 CHF (premixed). So, I've made a note that mixing on premises costs more.

We have then run out of the mixture again, so my husband went to the second (cheaper) pharmacy to buy another pot of premixed medicine. This time they have charged him 28 CHF.

As I was shocked to see that he same pharmacy that charged us 11 CHF two days ago, charged us almost triple price for the same medicine, I went to the pharmacy to ask them what was going on.

They have explained to me the following: 11 CHF is when one buys the medicine over the counter without a prescription. BUT, if you have a prescription, then they assume that you claim this money from the insurance company and then they charge you 28 CHF for the same medicine. I've said to them that last time we also showed a prescription, but they charged 11. The pharmacy manager said that they have made a mistake and should have charges us 28 CHF last time too. When I told him that another pharmacy mixed the medicine for 17 CHF, he said that that pharmacy also was wrong because the mixing itself costs 25 CHF without the cost of the ingredients, so the right costs should have been 42 CHF (!!!).

Then I've said: fine, forget about my prescription, I have no Swiss isurance company, so I am buying over the counter. In the end after some arguing they reimbursed the 17 CHF difference.

However, I am still puzzled:

1. if what the manager told me is true, why would Swiss insurance companies pay triple price just for the fact that this medicine was prescribed as opposed bought over the counter? This is not in their interest and unless they get some sort of payment back from the pharmacies I do not see any logic.

2. The fact that I have a prescription does not automatically imply that I will claim the money from the insurance. These are two separate and independent things. Or people here assume that if you have a prescription, then you have it because you want to claim the cost from the insurance company?

3. What should I do in the future when I buy medicine: check first if they sell it without prescription and then check how prices differ?

Note: I have no Swiss uinsurance. My international insurances reimburses the cost of prescribed medication. But, once it is prescribed, they do not care if I buy it over the counter or with prescription.

Finally, I noticed that some pharmacies charge additional surcharges for check-up, or something like that. Sometimes they prepare a label with instruction how to use the medicine (which is really not necessary as normally prescription has the instruction), but sometimes they just charge it. Once I've bought tablets which costed CHF 6, but there were surcharges on top of that price of CHF 7. Isn't it absurd? Can I refuse to pay surcharges?



I would be grateful for your thoughts on the above.

lana
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Old 09.06.2008, 11:18
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Re: Cost of Medication with and without prescription

There is an on-going court case in Switzerland between doctors & pharmacists regarding this issue as explained to me by my doctor. Pharmacists are trying to stop doctors being able to sell medicine directly to their patients since it costs them (the pharmacists) money & doctors are trying to stop pharmacists charging a surcharge for prescribed medicines since the pharmasists played no part in the diagnosis.
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Old 09.06.2008, 12:57
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Re: Cost of Medication with and without prescription

The pharmacies aren't required by law to sell all over the counter medication at a fixed price. It sounds like the tincture falls in this category. You can verify this by searching the circle-shaped Swissmedic logo on the packaging, which should have a big C, D or E letter. (If on the other hand there's an A or B, this story sounds stranger because those prices are fixed plus a very small consulting fee).

The OTC medications fall in two categories. Some will be paid by the mandatory health insurance if prescribed by a doctor (like Paracetamol or Voltaren), in which case there's a fixed price. But others are never covered.

Once you've made sure that the medication in question is OTC by searching a C/D/E letter, you can check if the expenses are covered and the price fixed by searching for it on the Spezialitätenliste (SL) here. It contains all meds covered by health insurance if prescribed (this includes the entire categories A and B).

Hopefully I've got everything right. I think there's a need for a thread about pharmacies in the future.
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Old 09.06.2008, 15:16
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Re: Cost of Medication with and without prescription

Hello,
the packaging is just a pot with a label saying Shuttelpinselung weiss. I looked everywhere for letters: no letters anywhere. Just the name of the manufacturer: Hanseler AG and their phone number. All this is strange.
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Old 09.06.2008, 15:42
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Re: Cost of Medication with and without prescription

This is the first time I heard that there is a difference in price when you pay yourself and when you have the prescription. It certainly does not seem right, but perhaps I just don't know. I know that where I buy certain medication prepared by the pharmacy I sometimes do not have the prescription (I get it later from the doctor and submit it to my insurance company together with the invoice) but they charge me the same amount. The price is actually printed on the label.

When it comes to surcharges, there are pharmacies (at least in Geneva) that do not charge them, so I usually go there. Sun Store is one such chain and I think they have a pharmacy in Zurich. There are also others, you have to find out where they are and how convenient it is to go there.
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Old 09.06.2008, 15:59
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Re: Cost of Medication with and without prescription

Yes, there was a label with the price on the pot (11 CHF), which they took off before they gave the pot to us charging 28 CHF.
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Old 10.06.2008, 10:30
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Re: Cost of Medication with and without prescription

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Hello,
the packaging is just a pot with a label saying Shuttelpinselung weiss. I looked everywhere for letters: no letters anywhere. Just the name of the manufacturer: Hanseler AG and their phone number. All this is strange.
Then I doubt that any mandatory health insurance would cover it. But I can't back this up with own experience.

Pharmacies sometimes sell homeopathic and other alternative medicine preparates, and maybe also low-level school medicine preparates without Swissmedic categorisation.

On a sidenote, Swissmedic has internal problems and a growing queue of medicaments waiting for testing and approval. The Swiss medicament agency has fallen down from excellence below European mediocrity.
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Old 10.06.2008, 11:20
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Re: Cost of Medication with and without prescription

My experience with Swiss medical care is this:
They are a MONOPOLY.
There are 3 parties to this :
1. doctors
2. pharmacies
3. insurance companies

It is an open-cheque policy with them when it comes to bills.

Pharmacies are paying lip-service to the insurance companies, who want to reduce costs of medical insurance.

Insurance companies are paying lip-service to the insured when they talk about reducing premiums.

As with MOST swiss companies and businesses (I am saying out loud, medical health service = BIG BUSINESS), they want to maximise their profits, minimise their work (like ensuring least cost and best options), and pass all the costs to the person who is sick.

I have dozens of reallife examples, too ****ty to quote already.

Just bear in mind, looking at your medical document for 2 mins over the telephone, can easily cost 50chf. Therefore don't ever rely on doctors, unless you are DYING.


These are my thoughts.
BTW, I buy very comprehensive insurance, and I have no qualms going to the most expensive hospital or clinic or paying huge sums for physio-massages for the slightest small ache.
Who cares if the premiums will go up for the "rest" of healthy people. Who cares? The industry goes on charging...
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Old 10.06.2008, 11:40
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Re: Cost of Medication with and without prescription

I am not aware of how this thing was organised. But I think it is awful.

Before. And I am talking 10 years ago, the reimboursement was done on the basis of the prescription, sent together with the pharmacy receipts to the insurance company. There were no surcharges.

So you had to pay in advance and send the bills to the insurance company who simply would check what was covered and what not and then sent you back a check with the reinboursement of the covered part of the bill.

Then there was a big debate about the problems this caused and how the pharmacists had to play a role about the control on how the prescription medicine was given and the standardisation of prices and fees.

So they created this "frais de dossier" thing, or the service your local pharmacy gives you to keep a file about your medication.

So in fact the pharmacy keeps record of the prescriptions you had and who prescribed them. This is simplified if you had a family doctor as you are obliged to pass through him for any medical treatment and so he also keeps record of your clinical history. Then you could have an insurance "credit card" that you could get the medicine from the pharmacy where you were registered without the need to pay in advance for it. The pharmacy took care of this control, register and reporting the invoices to the insurances company who woul then invoice you the non-covered part of the bill.

They wanted to do this also with the doctor invoices but the doctors didn't accepted the system.

Assura, and maybe other insurance companies also didn't took this credit-card system for the medicine, nor the mandatory family doctor. but the pharmacies charge you anyway the "management costs" when they sell you medicine under prescription. The procedure is the same as before ( 10 years ago ), with the extra fees, but without the advantage of non paying in advance.

Pharmacies also charge you for many other services as the mixing, labeling etc.

When you are registered at your pharmacy and have prescription medicine that needs to be bought again and again. The pharmacy keeps record of this and who is the doctor who prescribed it. So when you need a refill you can call the pharmacy and ask for the refill, the pharmacy has this on file and will call your doctor to ask him for a telephonic prescription and then they will deliver the medicine without the need that you go back to the doctor for the prescription.

This service off course costs, the pharmacy fees and also the doctor's telephonic service.
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Old 22.06.2008, 23:07
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Re: Cost of Medication with and without prescription

Apparently the prescribed "medicine" is classified as a cosmetic (prevent scars?). No insurance covers it. Pharmacies can decide the price as it is not on the insurance lists.

Pharmacies are entitled to charge a fee for verifying the prescription and maintaining records. Some pharmacies waive this charge.

The cheapest source are the mail order pharmacies. They waive the fees, give a small discount and invoice the insurer directly. Disadvantage: 2 workday delay, i.e. unsuitable in emergencies.
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Old 22.06.2008, 23:14
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Re: Cost of Medication with and without prescription

The charge made at pharmacies was agreed in exchange for a reduction in the cost of drugs. For a small item it can result in the price increasing but, overall, it has reduced the costs.

The charge is in two parts. One is a fee for dealing with the prescription and the other is for making, and keeping, a dossier. This can be a useful safety measure as if a drug is prescribed which is incompatible with one you are already taking the pharmacie should get a warning notice.

Last edited by Blonaybear; 23.06.2008 at 11:14.
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Old 17.09.2008, 23:26
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Re: Cost of Medication with and without prescription

Hey,
interesting story with those fees and history files... What if I take medicine in different pharmacies every time? Do they all have my dossier? And how can they warn me in this case? Does this fee come on the bill separately or is it impossible to figure that out (never saw anything like that on the check)?
Exactly today I got a prescribed medicine from a place, where I have been only once before but where they did some procedure with my insurance card, but surprisingly the lady didn`t find any record of me. So now after reading about those fees I get a feeling of being scammed at some point without even knowing it .
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Old 18.09.2008, 22:42
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Re: Cost of Medication with and without prescription

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Hey,
interesting story with those fees and history files... What if I take medicine in different pharmacies every time? Do they all have my dossier? And how can they warn me in this case? Does this fee come on the bill separately or is it impossible to figure that out (never saw anything like that on the check)?
Exactly today I got a prescribed medicine from a place, where I have been only once before but where they did some procedure with my insurance card, but surprisingly the lady didn`t find any record of me. So now after reading about those fees I get a feeling of being scammed at some point without even knowing it .
Better stay with the same pharmacy:
  • You are only charged once.
  • They might actually detect combination side-effects.
Not all pharmacies charge the counseling fee. You might consider mail-order pharmacies. They waive the fees, give you 5 to 10% discount and bill the insurer directly. Disadvantage of mail-order: 2 days delay, hence unsuitable for urgent medicines, but good for persistent medication.

If you fear combinatorial side effects, you can consult your primary GP, which is anyway a good idea so that he/she has a complete picture of treatments you might receive from various specialists.
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Old 19.09.2008, 00:17
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Re: Cost of Medication with and without prescription

Good point! To be very honest I never got to the idea to order meds on-line... Luckily, I don`t need them on a regular basis, and when I need... pharmacy is never on my way Thank you for a good idea.

Last edited by Sviz; 19.09.2008 at 00:18. Reason: typo
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Old 19.09.2008, 01:02
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Re: Cost of Medication with and without prescription

we found (living near the border in Basel) that prescription (and non-prescription) medications are WAY cheaper across the border, in France.... they accept Swiss prescriptions with no problems.....
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Old 19.09.2008, 07:26
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Re: Cost of Medication with and without prescription

BUT can you get reimbursed if from the Swiss insurance companies if you buy in France???
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Old 19.09.2008, 17:59
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Re: Cost of Medication with and without prescription

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Good point! To be very honest I never got to the idea to order meds on-line... Luckily, I don`t need them on a regular basis, and when I need... pharmacy is never on my way Thank you for a good idea.
Medicine mail-order is not online. They need to see the prescription. They give you free prepaid envelopes to send in the prescription. If urgent, you can also fax it. My GP is willing to do the faxing, too. So I can relax and await the parcel in 1 or 2 days.
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Old 14.10.2008, 15:06
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Re: Cost of Medication with and without prescription

So if the pharmacies know you're insured, they charge more for the medication?

Where are their ethics?
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Old 14.10.2008, 20:22
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Re: Cost of Medication with and without prescription

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So if the pharmacies know you're insured, they charge more for the medication?

Where are their ethics?
There were extended negotiations between the insurers and the pharmacies. The insurers wanted to discourage the pharmacies from giving out expensive "originals" (higher margin for the pharmacy) instead of cheaper generics. Therefore they agreed on a flat processing fee. Consumers pay 10% and the insurers 90%. So what is good for the insurers is also good for the consumers.

Those who are not insured can do comparison shopping, e.g. get mail order, buy abroad, etc.
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