Report shows extreme gap Mini-group causes drug expenditure to explode
The new Helsana Medicines Report shows a clear shift: a small group of patients is causing an increasingly large proportion of total expenditure.
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- A small group of seriously ill insured patients are claiming an ever larger share of total medication costs.
- High-priced areas such as oncology and immunotherapies in particular are driving up expenditure, even though the number of patients is only growing slightly.
- This concentration means that price reviews and transparency in reimbursement are becoming increasingly important.
The Helsana Medicines Report 2025 shows a pattern that has been intensifying for years: medication costs are increasingly concentrated on a very small group of patients. While the majority of insured persons incur comparatively low or constant expenditure, a growing proportion of the total costs are incurred by the most expensive one to five percent of cases.
According to the report, a "disproportionately high share of total expenditure" is attributable to those patients who are treated with high-priced medications. This includes a whole range of modern therapies that have been introduced in recent years and are now firmly established in everyday medical practice.
The data clearly shows that the surge in costs is not because significantly more people are becoming seriously ill. Rather, the treatments themselves are becoming more expensive. This is particularly evident in three groups:
- Oncology (cancer drugs): This category remains the biggest cost driver. Prices for new active ingredients are high and continue to rise. Many of these drugs are now among the most expensive in the entire system.
- Immunotherapies and autoimmune diseases: Here, too, the proportion of costs is growing disproportionately. The report shows that therapies are often used on a long-term basis - and can cost tens of thousands of francs per patient per year.
- Rare diseases: There are now a number of special preparations for this group that are reimbursed under basic insurance and incur very high annual costs.
The report states that the share of these therapy groups in total expenditure is growing significantly faster than the number of cases treated.
1 to 5 percent of people cause the majority of costs
While the costs of the most expensive patients are rising, the majority of insured persons remain stable or even incur lower costs than in previous years. This leads to an ever-widening gap: The least expensive 50 percent of insured persons only account for a small proportion of total expenditure. However, the most expensive 1 to 5 percent account for a significantly increasing share.
According to the report, this concentration has a considerable impact on the development of basic insurance. Even price reductions for individual medications can hardly slow down the trend: new, expensive therapies quickly compensate for these effects.
The report points out that this shift increases the relevance of price reviews, performance audits and transparency. This is because even small price differences have a major impact on overall expenditure, particularly in the case of medicines that incur very high costs per patient.
Helsana also emphasizes that the cost follow-up model and the annual review of high-priced preparations are crucial to cushioning the dynamic. Currently, prices are only reviewed every three years - too infrequently in the view of the authors.
