Swiss health insurers differ sharply in how often they approve case-by-case requests for cancer and rare-disease medicines, according to previously confidential federal data obtained by RTS after a five-year legal battle with the Federal Office of Public Health (FOPH).
The figures, covering 2017–2019, show approval rates ranging from 98% at KPT to 45% at Sanitas, against a national average of 76%. The revelations come as nearly 80,000 such requests were filed in 2025, and as the FOPH refuses to release more recent insurer-level data until its own evaluation is published in 2027.
What does Off-Label mean? The Off-label use refers to a medicine prescribed outside its officially authorised indication, dosage or method of administration. In Switzerland, insurers may cover such treatments case by case if the patient faces a life-threatening or seriously debilitating illness, no approved alternative is available, and a major therapeutic benefit is expected.
Insurers must consult a trusted physician before deciding, and must rule on a complete application within two weeks. Since 2024, insurers have been required to use the OLU-Tool, a shared assessment instrument for benefit categories.
The Insurers Behind the Numbers
KPT approved 98% of off-label reimbursement requests, followed by Assura at 96% and Groupe Mutuel at 94%. CSS was just below the national average at 74%.
At the other end, Helsana approved 67%, Atupri 53% and Sanitas 45%. The figures identify, for the first time, which insurers stood behind approval rates that the FOPH had previously published only anonymously.
RTS Wins Five-Year Transparency Battle: Insurers Contest the Comparison
The insurers’ umbrella body, prio.swiss, said it has “serious reservations” about comparing the FOPH data across companies, arguing that the study was interpreted and implemented differently by each insurer. It says the 2024 reform requiring the OLU-Tool has addressed that problem.
Sanitas, the insurer with the lowest recorded approval rate, said therapeutic trials had been counted as refusals in the study. It claims that if those trials were counted as favourable decisions, its approval rate would have been around 80%.
Identical Files, Different Answers
The underlying 2020 FOPH study tested the system by submitting an identical fictitious case to 16 major insurers. Three approved the treatment, four refused it, six proposed a therapeutic trial and three requested further information before deciding.
The study concluded that there was “unequal treatment” among people covered by Switzerland’s compulsory health insurance system. RTS also examined CHUV oncology cases from 2020 to 2025 after insurers declined to provide more recent approval rates, and found that the highest- and lowest-approving insurers remained broadly the same.
A Transparency Fight With Stakes
RTS obtained the original insurer-level data after a five-year legal process, including a ruling by the Federal Administrative Court. The broadcaster’s reporting comes three weeks before Switzerland’s 30 November deadline for policyholders to switch health insurers, sharpening the political and consumer significance of the findings.
The FOPH says it will not release 2025 insurer-level data until its own report, due in 2027, is completed. That means patients choosing or reconsidering insurers this month will not have access to the most current comparison of how often each company approves potentially life-saving off-label treatments.
Why It Matters?
For cancer and rare-disease patients, an off-label medicine can be the difference between having a treatment option and not having one. Swiss Cancer League research cited by the FOPH-linked debate has previously shown that off-label treatment is widespread and that reimbursement is not uniform.
The new disclosures turn an abstract regulatory debate into a consumer-facing issue: two patients with comparable medical cases may face materially different odds of reimbursement depending on which insurer they belong to. The question now is whether the 2024 reforms have genuinely narrowed that gap—or whether patients will have to wait until 2027 to find out.
READ MORE: Zurich Affordable Housing: City Plans To Use CHF 2.5 Billion For Property Revaluation
