SL Insight Newsletter #12

As of January 1, 2026, Mounjaro (tirzepatide) will be reimbursed under the Specialty List. This unexpected inclusion comes with strict rules: reimbursement will be closely tied to criteria, cost approval/documentation requirements, and discontinuation rules.

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key points

• Access is operationalized via limitation text (not via delay)
• Obesity/weight management: Cost approval, structured documentation, and stop rules as key control levers
• Managed entry in SL design: visible list price, but net price/cost-controlling "price models" in the background

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MFN / GENEROUS Impact?

With SL listing, the Swiss price anchor becomes earlier and more visible, which increases its international reference relevance. At the same time, the BAG logic of "list price visible, net costs via pricing models" supports the strategy of limiting price exposure internationally.