Information on cost reimbursement through mandatory basic health insurance
Since 2017, pharmacogenetic analyses are included in the Federal list of analyses, which specifies tariffs for laboratory analyses and the terms under which the costs of analyses are covered by the Swiss mandatory basic health insurance. With their addition to this list, the costs of pharmacogenetic tests are now covered through the compulsory health insurance in cases where certain limitations are met.
Specifically, these limitations include:
- The pharmacogenetic test must serve the medical treatment of an illness or its consequences. Specifically, the result of the test must have actionable consequences for the treatment of the patient, in whom the test is performed.
- Costs are only covered if the pharmacogenetic test is performed for a medication, for which the patient currently has an indication or with which the patient is currently undergoing treatment.
- Pre-emptive testing (i.e. performing pharmacogenetic tests for medications in a patient that currently does not have an indication for said medication) is not covered under the current limitations.
In addition, there are important limitations regarding the prescription of pharmacogenetic tests:
- Only certain pharmacogenetic tests can be prescribed by any physician, independent of the specialization. These tests are defined in a list provided and maintained by the Swiss Society of Clinical Pharmacology & Toxicology (SSCPT). This list currently includes the following gene-drug pairs
- Abacavir: HLA-B*57:01
- Carbamazepine: HLA-A*31:01, HLA-B*15:02
- Thiopurines (azathioprine, 6-mercaptopurine): TPMT
- Fluoropyrimidines (5-fluorouracil, capecitabine): DPYD
- Irinotecan: UGT1A1*28
- All other pharmacogenetic tests (i.e. any test not included in the SSCPT list) must be prescribed by a physician with specialization in Clinical Pharmacology and Toxicology (with corresponding Swiss federal medical specialization title, or federally approved medical specialization title in Clinical Pharmacology and Toxicology).
For tests, which require prescription by a specialist in clinical pharmacology and toxicology, clinical pharmacology consultation services are available in all regions of Switzerland. A list with contact information can be found under the following link: https://naturwissenschaften.ch/organisations/sscpt/activities/clinical_consultations
Pharmacogenetic tests are genetic analyses and therefore fall under the Federal Act on Human Genetic Testing (LAGH – GUMG SR 810.12). As such, pharmacogenetic tests may not be performed unless the person concerned has been provided with adequate information about the test and has given his or her voluntary consent.
To ensure compliance with this law, laboratories performing pharmacogenetic tests require a written consent signed by the patient along with the test order. In addition to providing the consent itself, this form also allows the patient to specify whether or not any remaining biological material (i.e. blood, DNA) should be stored for any potential future analyses, and whether it may be used for quality testing or research purposes.
A template for patient information about pharmacogenetic testing and a consent form for pharmacogenetic tests can be downloaded here: