{"id":29320,"date":"2026-10-28T09:13:13","date_gmt":"2026-10-28T09:13:13","guid":{"rendered":"https:\/\/quickbirdmedical.com\/?post_type=news&p=29320"},"modified":"2026-10-28T09:22:03","modified_gmt":"2026-10-28T09:22:03","slug":"diga-switzerland-reimbursement-migel","status":"publish","type":"news","link":"https:\/\/quickbirdmedical.com\/en\/news\/diga-switzerland-reimbursement-migel\/","title":{"rendered":"DiGA Switzerland: Unfavorable Reimbursement Terms for DiGA in the MiGeL"},"content":{"rendered":"

Since July 1, 2026, the List of Means and Appliances (MiGeL) of mandatory basic health insurance in Switzerland has included a separate chapter for digital health applications<\/strong> (dGA). These are the Swiss counterpart to DiGA. So far, the chapter contains only one item, 40.01.01.00.1. It covers interactive dGA for cognitive behavioral therapy for mild to moderate depression. Certain physicians can prescribe them as a supplement to psychotherapy or until it begins.<\/p>\n

Maximum reimbursement amount for the depression item<\/h3>\n

The assessment was based on deprexis, but the item is generic. Its maximum reimbursement amount (HVB) is already determined using the new calculation model for dGA. In the listing decision of December 2025, the HVB was set at CHF 171.32 (approx. \u20ac185) per license for 90 days. However, there was no calculation basis for dGA yet. Therefore, the item was placed under evaluation until the end of 2026<\/strong>.<\/p>\n

With the amendment of June 9, 2026, the Federal Office of Public Health (FOPH) recalculated the HVB using the model. As a result, it rose to CHF 193.32 (approx. \u20ac209). This is only the upper limit of what mandatory basic health insurance reimburses, though. The actual price of deprexis is CHF 271.32 (approx. \u20ac293). Supplementary insurance often covers the difference of CHF 78 (approx. \u20ac84). Otherwise, insured persons pay it themselves. For comparison: In Germany, the manufacturer price listed in the DiGA directory is \u20ac228 for 90 days. There, statutory health insurance (GKV) covers it in full.<\/p>\n

How the calculation model works<\/h3>\n

The calculation model works in two stages. Initially, the HVB covers ongoing operating and maintenance costs. In addition, it covers market entry costs spread over three years, based on the projected annual number of uses. At most, however, it reaches an anchor price. For this anchor price, prices of comparable, permanently listed DiGA from the German directory are also taken into account.<\/p>\n

Only 15% of development, operating and maintenance costs are attributed to Switzerland. On top of that comes a flat CHF 250,000 for Swiss market entry<\/strong>. Once the cumulative reimbursement since listing reaches the market entry costs, a reduced HVB applies. It then only covers ongoing costs. For this reason, the depression item remains under evaluation until June 30, 2029. By then, the FOPH will check whether this threshold has been reached. It will then calculate the reduced HVB using data from the applicant.<\/p>\n

Three applications rejected<\/h3>\n

The FOPH rejected three further dGA applications<\/strong>, mainly due to unclear evidence of efficacy. They concerned borderline personality disorder, physiotherapy training for back and hip pain, and monitoring macular diseases. For manufacturers, the key question is therefore whether the Swiss market remains economically viable once the threshold has been reached.<\/p>\n

The calculation model applied can be found here: Calculation model for the HVB of dGA (PDF, German)<\/a><\/p>\n","protected":false},"featured_media":0,"template":"","categories":[],"tags":[],"display":[54],"class_list":["post-29320","news","type-news","status-publish","hentry","display-display-on-news-page"],"acf":[],"yoast_head":"\nDiGA Switzerland: Unfavorable MiGeL Reimbursement<\/title>\n<meta name=\"description\" content=\"DiGA Switzerland: Since July 2026, the MiGeL has reimbursed dGA. 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