Helsana-Report: Drug Report 2024
For the first time ever, medications make up the biggest cost block in basic insurance

Despite the regular price reviews conducted by the Swiss Federal Office of Public Health (FOPH), which oversees the prices of medicines, the costs for medications under basic insurance rose sharply again in 2023. At CHF 9 billion, they make up the biggest cost block in basic insurance. 6.9 million people (1.5% more than in the previous year) purchased 137 million packs of medication (+2.1%), resulting in a total additional cost of CHF 500 million (+5.9%).

The cost increases are primarily a result of new launches and increases in the volumes of new medication in the high-price segment. This is causing per capita costs to rise (+4.3%), particularly when it comes to modern treatments. This trend has been observed for many different active ingredient groups. The average annual costs of the five most expensive cancer medications, for example, were around CHF 90,000 per person. A standard review of cost-effectiveness (pricing) that takes volumes into account, and a corresponding adjustment of prices when volumes are increased, could go some way towards keeping a lid on increased costs. The prices of medications used as standard treatments could also be reduced, since those medications are no longer as innovative as they once were.

Here are some examples of this:

• The three medications that generate the greatest revenue – the cancer drug Keytruda®, the eye medication Eylea® and the anticoagulant Xarelto® – still generated the most costs in 2023. Together, they account for costs amounting to just under CHF 500 million, which is 5.3% of the total medication costs.
• Cancer and immune system drugs account for CHF 2.8 billion or around 30% of the total medication costs, despite only making up 2.7% of all purchases. The CHF 245 million year-on-year increase in costs can mainly be attributed to an increase in the market volumes of expensive medications. The growth in costs has also been fuelled by quantity increases due to the expansion of indications.
• Despite there only being a slight increase in purchases (+0.5%), the costs associated with nervous system drugs rose by CHF 32 million (+3.0%), also due to the increased market penetration of costly treatments. More medications were used to treat depression and ADHD, for example, which led to a sharp increase in revenue.
• There was a marked increase in costs for lipid-lowering medicines (+ CHF 31 million, or 12.0%), mainly due to the growth of PCSK9 inhibitors and new medications that work in similar ways.
• Other medications moved up into the group of products that generate the highest costs on account of increased sales. These include the monoclonal antibody Darzalex®, the immunoglobulin Privigen®, the anticoagulant Eliquis® and the diabetes drug Ozempic®.

Patent protection plays a key role in the pharmaceutical industry. This gives the patent holder the exclusive right to market a new drug for a certain amount of time. During this time, no other company may sell or import the protected medication without permission. This protection is necessary in order to pay off the costs of clinical research and the licensing process. Once a drug’s patent protection has expired, other manufacturers can introduce copycat products (known as generics and biosimilars) onto the market. The timing of this can be delayed, however, by means of various different strategies involving secondary patents and legal disputes. According to Swissmedic, generic medications and biosimilars can be used as substitutes for the original drugs without any differences in their therapeutic efficacy, tolerability or safety.

Products on the specialities list (SL) with no copycat versions still account for two thirds of outpatient medication costs. This figure is low compared to other countries. In order to reduce the share of original products, there needs to be more of an incentive to launch copycat products in Switzerland.

The average price per pack of original medications upon inclusion in the SL has almost doubled to CHF 1500 in recent years. In the case of entirely new active ingredients, it even amounted to almost CHF 6,000 in 2023. The FOPH’s three-year review and the pressure from less expensive copycat products exert a negative influence on the prices of original medications, but this is not enough to offset the increase in prices. As a result, total costs also rise, and original drugs generally remain more expensive even when copycat products are launched. Combined with the preference for original medication, this results in unused potential for savings.

There is still significant unused potential for savings associated with the use of generics and biosimilars (or lack thereof). For the period from 2020 to 2023, this potential amounts to a total of over CHF 1.2 billion. Although some progress has been made, the market for most biosimilars is sluggish. The first biosimilar for Adalimumab, for example, came onto the market five years ago. The proportion of biosimilars is still just 25%. In 2024, a number of changes to the law took effect that aim to help make the use of generics and biosimilars more widespread. The next pharmaceuticals report will show whether these measures are adequate.

Janus kinase inhibitors (JAK inhibitors) are a highly effective group of relatively new medications that are used, among other things, to treat various chronic inflammatory and autoimmune diseases (see box). In 2023, just over 10,000 people in Switzerland took JAK inhibitors, most commonly for rheumatic diseases. Studies have shown that, in certain situations, JAK inhibitors are effective in the long term, take effect rapidly, and are easy to take in tablet form.

Although JAK inhibitors are highly effective, they are also costly and have a lot of potential side effects. The total annual medication costs for JAK inhibitor patients in the field of rheumatology amount to around CHF 16,000, which is roughly 60% higher than for those who no longer take JAK inhibitors. Safety concerns have also arisen in recent years – particularly for older patients with cardiovascular risk factors. As a result, various licensing authorities around the world have issued safety warnings. In March 2023, Swissmedic expanded the warning and updated the corresponding labelling of specialist and patient information for all JAK inhibitors licensed for inflammatory and dermatological diseases (Abrocitinib, Baricitinib, Tofacitinib, Upadacitinib). Other JAK inhibitors (Ruxolitinib and Fedratinib) were excluded from the warnings. This means that treating physicians must take the risks and side effects into account, carefully weigh them up and inform patients accordingly when deciding on treatment.

Helsana’s settlement data and international studies show that people with rheumatism who use Jak inhibitors experience critical incidents more frequently than those who do not use them. This is particularly true for thromboembolism, serious infections, cardiovascular events and death. On average, people who use JAK inhibitors experience such events around 60% more often than those who do not.

There was a steady rise in purchases of JAK inhibitors during the period under review. The first warning was issued and the clinical guidelines were amended in 2019, as a result of which the prescription patterns were presumably modified and purchases fell. The warnings were expanded to include three other JAK inhibitors in early 2023. Despite this, Upadacitinib, one of the active ingredients included in the warning, was still frequently used. In the absence of alternatives, it seems doctors prescribe it as an effective option if patients respond well to the treatment and the doctor uses the medication in full knowledge of the potential risks.

The safety issues have a significant impact on the cost-benefit ratio for JAK inhibitors for patients in high-risk groups. Their cost-effectiveness is reduced by the costs of monitoring patients and treating the negative side effects, which only became known over time. It would therefore be reasonable to reduce the price of JAK inhibitors. It is important to carry out a careful risk analysis in order to ensure patient safety and make the best possible decisions regarding treatment.

Lung cancer is one of the most common forms of cancer (see box) involving malignant tumours that develop in the lungs or airways. Abnormal cells undergo uncontrolled growth, and can spread to other parts of the body. The treatment of lung cancer has changed significantly, with targeted treatments and immunotherapies. The first targeted therapy was approved in Switzerland in 2004, followed by the first immunotherapy in 2016.

The total costs for oncological medications have risen significantly in recent years, as illustrated by the example of lung cancer. The trend is particularly pronounced in this indication category because lung cancer is one of the most common forms of cancer. The significant increase in costs is not due to an increase in cancer cases, but rather the high prices of new therapies that often supplement rather than replace existing treatments.

The average incidence (i.e. the number of new cases) is around 4,900 per year. Three quarters of these cases were treated with at least one oncological agent in 2023. The use of chemotherapy has fallen over the years, while targeted therapies are used more frequently. The sharp rise in the use of immunotherapies is particularly noteworthy in this regard. The addition of this form of therapy to the SL in 2016 does not seem to have significantly affected the use of the other two treatment options. One reason for this is that immunotherapies are often administered in combination with chemotherapy. It is also not uncommon for patients to undergo multiple different consecutive treatments in the course of a year.

Although the number of people with lung cancer has remained relatively stable, the costs have risen significantly due to an increase in treatments using expensive oncological agents. These costs have increased from CHF 63 million in 2013 to their current level of CHF 146 million, mainly due to immunotherapies with annual costs of around CHF 100 million. The actual costs can vary significantly between cases, depending among other things on what time of year treatment starts and how long it is administered for. The most costs incurred for a single individual in 2023 came to around CHF 140,000.

A large majority of lung cancer patients have only received one course of treatment to date. There are a number of possible reasons for this. Some of the patients will have died, for example, while others will be in a stable condition and not require any further treatment for the time being. In 2021, 50% of lung cancer patients received chemotherapy as their first treatment. During the three-year observation period, 70% received no further oncological agents and 20% died. Of those who received further treatment, the smallest proportion (30%) received another course of chemotherapy. Many more received immunotherapy (42%) or immunotherapy in combination with chemotherapy (23%). A third-line treatment was only used in very rare cases. Targeted therapies were provided as a first-line treatment to 13% of patients. Immunotherapy was used as a monotherapy or in combination with chemotherapy for 14% and 23% of patients respectively.

The treatment patterns for lung cancer patients who received their first medicinal therapy in 2021 are very different to those from 2016. Generally speaking, the treatment paths in 2016 were less complex. A large number of new studies and corresponding revisions of the guidelines for the application of therapies have resulted in their more differentiated use. As a result, the focus of the cost issue is on the approval and increased use of immunotherapies. These therapies, which use the body’s own immune system to target cancer cells, are increasingly also being used as first-line treatments. This means that they are being used for more patients, as clearly reflected in the rising treatment costs and total costs.

You can find more detailed information, including the methodology used, comprehensive figures and a large number of facts and charts relating to the above topics and specific sections in the “Helsana Report: Pharmaceuticals 2024”. The special chapters on JAK inhibitors and lung cancer as well as the comprehensive chapter on the market development of drugs with regard to patent status, mechanism of action, active ingredient and specific preparations provide a detailed insight into the topics covered.