FAQ for professionals

From 1 July 2024, HIV PrEP will be covered by compulsory health insurance, subject to certain conditions. This will have implications for both availability and costs.

Start preparing now, so that your clients can have PrEP costs covered by their health insurance and remain protected against HIV without interruptions.

HIV PrEP: Cost Coverage by Health Insurance Starting from 1 July 2024

What will this decision mean for the availability of PrEP in Switzerland?

From July 2024, PrEP users will need to visit a SwissPrEPared centre to get PrEP through their health insurance. Nevertheless, users do not have to participate in the SwissPrEPared programme or the study.

Due to this change, PrEP will no longer be available in some regions of Switzerland. Also, there are likely to be some GPs and other doctors, presumably mostly in urban areas, who currently prescribe PrEP but are not affiliated with SwissPrEPared.

This could lead to increased demand. Be prepared for this. It is crucial to ensure uninterrupted access to PrEP, even for clients who have switched over to you. Play your part in making sure there are no supply problems.

My practice or clinic is not affiliated with SwissPrEPared. Can I still participate?

Yes. Centres interested in participating should contact SwissPrEPared as soon as possible.

New centres are expected to accept a minimum number of patients. GPs with a small number of PrEP users are advised to issue referrals to SwissPrEPared centres.

Should we continue to offer PrEP that is paid for by the patients themselves?

Absolutely. Ideally, you should offer both a compulsory health insurance and a self-payment option for PrEP. There will be clients who for personal, financial or legal reasons can’t or don’t want to go through compulsory health insurance. It is important that PrEP remains available to these individuals too.

Will the insurance reimburse the price of the original medication (Truvada®) or of a generic version? How much will this be?

The combination drug tenofovir 245mg/emtricitabine 200mg is recommended.This is still unknown (as of 30 April 2024). Health insurance only covers the costs of medicines that are included in the Spezialitätenliste/Liste des spécialités. These are the products from Mepha and Viatris (as of 15 July 2024). The maximum reimbursement price is set at CHF 72.-. The product is available for only CHF 49.- via the Schaffhauserplatz pharmacy online shop (www.swissprep.ch). Inform patients accordingly to save costs.The maximum reimbursement price is also specified there.

Can non-physician practitioners also bill PrEP costs through compulsory health insurance?

Yes. Medical consultations can be delegated to support staff if the responsible physician is available, meaning the supervising person must be present and on site in person.

To be able to bill through compulsory health insurance, the supplier must be an authorised service provider. It is not enough to merely be affiliated with SwissPrEPared. The rules on this differ by canton.

Where can I find out more about the medical aspects of PrEP?

The current guidelines can be found on the SwissPrEPared website. If you have any questions, you should contact the infectious disease consultation service at your local hospital.

Which practices and clinics can bill PrEP via health insurance?

The participating centres can be found on the SwissPrEPared website.

What should be considered with regard to data protection?

In the field of medical practice, sexual health and sexuality are still highly stigmatised topics. Recent studies by the FOPH have shown that sexual minorities in particular face significant challenges relating to trust, access and resources within the healthcare system.

It is therefore crucial that healthcare professionals create a reliable, trustworthy and safe environment. For example, young adults who are still covered under their parents’ health insurance must be adequately informed about it.

However, there might be instances where health insurers ask for justification of the costs before they can cover them. Strictly speaking, only the medical review service of the insurance company should request this information. In practice though, you will often be contacted by other departments. Never tell them any very personal details about your sexual behaviour. Instead, ask that the medical review service submits a written request for the justification of the cost coverage.

Also, do not disclose the entire case history, but only what is necessary for justifying the costs.