Switzerland’s federal auditor has identified substantial weaknesses in the system intended to pass medicine-purchasing discounts and rebates through to insurers and patients. If effective enforcement cannot be achieved, it says policymakers should consider replacing these provider-level purchasing benefits with lower regulated medicine prices.
The Swiss Federal Audit Office (Eidgenössische Finanzkontrolle, SFAO) estimates that manufacturers provided medical practices, pharmacies and hospitals with up to CHF743 million in discounts, retrospective rebates and other benefits in 2024 – around 8% of medicine turnover. The estimate excludes wholesaler arrangements and remains uncertain because comprehensive market data are unavailable.
Swiss law generally requires such purchasing advantages to be passed on to insurers or insured people. Providers may retain part of them under specific agreements where the money supports demonstrable improvements in treatment quality.
SFAO estimates that only CHF88 million, or around 12% of the identified benefits, ultimately reached insurers or patients. Around CHF655 million remained with healthcare providers, although the audit does not regard all of this as necessarily unlawful. It identifies at least CHF266 million of percentage-based reductions that it considers sufficiently similar to discounts to require pass-through.
SFAO describes supervision by the Federal Office of Public Health (Bundesamt für Gesundheit, FOPH) since 2020 as ‘barely effective’. During that period, no order requiring repayment and no completed criminal sanction for unlawful retention had been imposed.
The audit therefore raises a broader pricing option. If the existing pass-through system cannot be made effective, SFAO says Switzerland could consider restricting provider-level discounts and rebates and capturing the saving directly through lower medicine prices.
Source: Swiss Federal Audit Office
Link: Prüfung der Aufsicht im Bereich Integrität, Transparenz und Weitergabepflicht von Vergünstigungen bei der Medikamentenabgabe (Audit of supervision of integrity, transparency and the obligation to pass on advantages when dispensing medicines)
Date: 12 August 2026
