{"id":27826,"date":"2026-04-30T04:00:00","date_gmt":"2026-04-30T02:00:00","guid":{"rendered":"https:\/\/www.thebrokernews.ch\/?p=27826"},"modified":"2026-04-29T15:19:41","modified_gmt":"2026-04-29T13:19:41","slug":"eyeinjections-cheaper-premiums-not-falling","status":"publish","type":"post","link":"https:\/\/www.thebrokernews.ch\/en\/eyeinjections-cheaper-premiums-not-falling\/","title":{"rendered":"Eye Injections Cheaper: but Premiums Are Not (yet) Falling"},"content":{"rendered":"
Eye injections cheaper, but cost reductions reach premium payers with a delay. Pic: Generated by AI.<\/span><\/div>\n\n

The new outpatient flat rates are having an effect: drug prices are falling and competition is increasing. However, from the insurers’ point of view, a complex conflict of objectives arises between cost containment, freedom of therapy and system logic. With unclear consequences for premium payers. <\/strong><\/p>\n\n

Since the beginning of 2026, eye injections have been part of a fixed outpatient flat rate. For insurers, this system change is more than just a tariff adjustment, it is an intervention in the market mechanics. For the first time, there is a direct financial incentive for service providers to purchase medication more cheaply. <\/p>\n\n

The effects are immediately visible. Prices for established preparations have fallen significantly, in some cases far below the official list prices. At the same time, alternatives and copycat products are being pushed more strongly onto the market. What has shown little movement for years is suddenly developing momentum. <\/p>\n\n

This is basically a positive signal for insurers: the price pressure is working.<\/p>\n\n

The downside: margin shift instead of premium relief<\/h6>\n\n

However, the benefits are not yet being realized where they are systemically expected. While purchase prices are falling, flat rates remain at a higher, historically calculated level. The difference is currently being realized by the service providers. <\/p>\n\n

This shifts the margin away from the pharmaceutical industry and towards specialized clinics. For the time being, there will be no relief for policyholders and premium payers. From an insurance perspective, this is a classic transitional distortion, but not a sustainable solution. <\/p>\n\n

The crucial question is therefore not whether the system works, but when the effects will be realized in the premium reality.<\/p>\n\n

Freedom of therapy under pressure?<\/h6>\n\n

At the same time, the professional debate is intensifying. Representatives of the ophthalmology profession are warning that the integration of medication into the flat rates could create undesirable incentives. Specifically, there are accusations that cheaper preparations are increasingly being used, even when more expensive, longer-acting drugs would be medically appropriate. <\/p>\n\n

Patient organizations report an increasing number of changes that are not always comprehensible to those affected. Although the professional association emphasizes that therapeutic decisions will continue to be made on the basis of evidence, it is also calling for a structural correction: drugs should be reimbursed separately again to ensure the independence of medical decisions. <\/p>\n\n

This reveals a central conflict of objectives. What functions as an efficient incentive from a cost perspective can be perceived as a potential distortion from a medical perspective. <\/p>\n\n

System issue or distribution issue?<\/h6>\n\n

This demand is ambivalent for insurers. While separating services and medicines would create transparency, it would also reduce the very price pressure that has triggered the current price declines. <\/p>\n\n

Experience shows that without integrated incentive systems, healthcare markets often remain sluggish. Flat rates have broken through this inertia. A return to individual service remuneration would very likely weaken this dynamic. <\/p>\n\n

This shifts the debate from a system issue to a distribution issue: who should benefit from the efficiency gains? Pharmaceuticals, service providers or the insured?<\/p>\n\n

Increasing legal and political pressure<\/h6>\n\n

The tensions have now also reached the legal level. A major pharmaceutical supplier has taken legal action and wants to have the inclusion of medicines in the flat rates reviewed. The background to this is the fact that manufacturers’ prices are regulated by the state, but are effectively undermined by the flat rates. <\/p>\n\n

At the same time, there is a regulatory hurdle: tariff decisions by the Federal Council can only be reviewed by the courts to a limited extent. This means that the dispute is increasingly shifting to the political and tariff partnership arena. <\/p>\n\n

The blind spot: speed of adaptation<\/h6>\n\n

Regardless of these conflicts, one point remains central from an insurance perspective: the speed at which the flat rates are adjusted. Because this is precisely where it is decided whether the system is effective. <\/p>\n\n

Falling drug prices must be translated into lower flat rates in a timely manner. Otherwise, some of the savings will remain tied up in the system. The current situation clearly shows this delay. <\/p>\n\n

At the same time, industry voices confirm that the price reductions are real and are already creating scope for adjusting the flat rates. In a next step, this lever could be used to actually bring the relief to the premium payers. <\/p>\n\n

A fragile balance<\/h6>\n\n

The developments surrounding eye injections are a good example of how sensitive the interplay of incentives is in the healthcare system. Flat rates can create competition and reduce prices, but they also intervene directly in medical decision-making and shift economic interests. <\/p>\n\n

It remains crucial for insurers that the efficiency gains achieved do not remain in the system. The current dynamic is progress, but not a sure-fire success. <\/p>\n\n

Whether this results in a sustainable reduction in premiums depends less on the basic model than on its fine-tuning. This is precisely what is now under discussion. <\/p>\n\n

Binci Heeb<\/p>\n\n

Read also: Helsana focuses on strategy, stability and new healthcare fields<\/a><\/p>\n\n

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