Effective correspondence: How letters encourage patients to switch to generic drugs.
Text: Tobias von RohrA Swiss study found that patients who received personalized information from their health insurer were around four times more likely to choose cheaper medication. The findings also helped prompt a change in federal policy.
Key takeaways
- Patients who received a personalized letter from their health insurer were around four times more likely to switch to a generic drug.
- Patients switched even when they stood to gain little or nothing financially, helping reduce overall healthcare costs.
- The findings helped inform the Swiss Federal Council’s decision to allow insurers to resume sending targeted information about generic drugs.
For many people suffering from chronic illnesses, prescription medicines are part and parcel of everyday life in Switzerland. These are used, for example, to regulate blood pressure, relieve pain or stabilize a person’s general state of health. At the same time, these drugs involve substantial costs for patients and health insurers alike. Considerable savings could in fact be made by using generic versions, copycat preparations of the original drug. But many patients are simply unaware of this option.
Some years ago, the health insurance company CSS began informing its clients about the option of cheaper generic medicines. Whether this had the desired financial effect, however, remained for some time unknown. That was until economist Nicolas Schreiner from the University of Basel looked at this very question in his work at the CSS Institute for Empirical Health Economics. Together with a team of researchers, he evaluated insurance data on 60,000 informational letters and a total of 540,000 drug purchases.
The results came as a surprise even to him. Specifically, those who received a letter subsequently switched to the generic drug much more often. Indeed, they were around four times more likely to do so than those who had not received the letter. “We don’t usually see such pronounced effects in economics,” says Schreiner.
How the study impacted politics
The results even drew the attention of policymakers. In 2022, the Federal Office of Public Health (FOPH) had prohibited health insurers from specifically notifying their clients of suitable generics. At the time, the rationale of the FOPH was that responsibility for providing advice lay primarily with medical service providers such as physicians or pharmacists and that using claims data to provide targeted information was not permitted under the compulsory health insurance system. In July 2026, however, the Federal Council once again permitted this practice.
The results of the study by Schreiner and his colleagues were a key factor in this decision, and the economist is clearly pleased about this: “The law was revised even before the peer review and final publication of the study. It feels good to contribute to something that impacts the whole country on a daily basis.”
From generic drugs to prevention
A personalized letter differs significantly, Schreiner emphasizes, from a general health campaign: Whereas information that goes out to everyone at the same time is quickly forgotten, a personal notification can have a much greater impact. “What is innovative about the mailing is not so much the information about generic drugs itself, but rather the specific, personalized and timely form of the communication,” says Schreiner.
The study shows that a mailing on generic drugs could be just the beginning. For example, health insurers could also reduce costs by reminding their clients of preventive measures at the appropriate time, such as a vaccination, a medical check-up or another medically recommended service. Nevertheless, Schreiner says that a discussion is needed about the boundaries: What recommendations are health insurers allowed to make to their clients? And to what extent should they be able to influence people’s decisions? He therefore believes that the current opt-out model is a sensible one, everyone has the option to request not to receive personalized information based on their individual situation.
Ultimately, he says, the decisive factor is that the information is actually in the patient’s interest. This presents another challenge, however: “Who decides what information is helpful?”
A new perspective on healthcare
As well as demonstrating a way to reduce costs in the healthcare system, the study also raises a fundamental question: How effectively can people make decisions about healthcare if they don’t even know which options are open to them? Financial incentives can only work if patients know about the options that are available.
Schreiner was particularly interested to find that people reacted to the letter and switched to a generic drug even if they stood to gain nothing financially. Many patients who need to take medication on a regular basis quickly reach their annual co-pay limit and have barely anything to gain from switching to a cheaper alternative. “This is a fascinating effect. Reducing overall health costs is helpful to society even if it’s of no direct benefit to the individual,” says Schreiner.
In Switzerland, numerous effects in healthcare remain unexplored, and researchers are gradually beginning to draw on modern empirical methods from the field of microeconomics. For Schreiner, the large dataset from the CSS Institute opens up the prospect of addressing further research questions, such as what people decide to do when their family doctor is on holiday: Do they prefer to go to the emergency room with their medical issue or do they wait and therefore alleviate demand on medical services? “We can ask a question in the morning and have an initial idea of the answer by lunchtime.”
More articles in this issue of UNI NOVA (November 2026).