The medical route in Switzerland: the legal framework

20 October 20268 min read

The legal rules in order: the 2022 change in the law, who may prescribe, the narcotics prescription form, pharmacies, costs, cantons and our consultation.

Medical treatment with cannabis medicines in Switzerland follows the rules of narcotics law. A licensed physician decides whether treatment is medically indicated, any prescription is written on an official form, and dispensing takes place through licensed pharmacies. This article sets out these rules in order, together with our consultation, and links to the pages that explain each point.

The legal basis since 1 August 2022

Since 1 August 2022, the Narcotics Act (BetmG) prohibits the cultivation, import, production and placing on the market of cannabis-type narcotics only insofar as they are not used for medical purposes (Art. 8 para. 1 let. d BetmG). Cannabis for medical purposes is therefore no longer a prohibited narcotic. It is still a controlled one: it is listed in Verzeichnis a of the narcotics lists ordinance (BetmVV-EDI), the list of substances subject to all control measures (Annex 2 BetmVV-EDI).

Since the same date, any licensed Swiss physician may prescribe medical cannabis where medically indicated. No exceptional authorisation from the Federal Office of Public Health (BAG) is required (Art. 8 para. 5 let. b BetmG; BAG).

According to the BAG, responsibility for the treatment lies with the treating physician. Narcotics may be prescribed only to the extent required by the recognised rules of medical science (Art. 11 para. 1 BetmG).

More: what changed in 2022, legal situation in Switzerland, the 1 percent limit and hemp products.

Who may prescribe

Physicians who practise under their own professional responsibility within the meaning of the Medical Professions Act (MedBG) are authorised to prescribe narcotics (Art. 10 para. 1 BetmG; Art. 45 BetmKV). Neither the Narcotics Act nor the BetmKV requires a postgraduate title in a particular field for prescribing cannabis medicines. Practising under one's own professional responsibility requires a cantonal licence to practise (Art. 34 para. 1 MedBG); for physicians, the licence requires, among other things, a federal postgraduate title (Art. 36 MedBG).

More on the question: who may prescribe.

The narcotics prescription (Betäubungsmittelrezept)

Where a cannabis medicine is medically indicated, narcotics law sets the form of the prescription. Controlled substances of Verzeichnisse a and d must be prescribed on the official narcotics prescription form (Art. 46 para. 2 and 3 BetmKV). Because cannabis for medical purposes is in Verzeichnis a, cannabis medicines with at least 1.0 percent total THC are prescribed on this form.

The Narcotics Control Ordinance (BetmKV) sets the rules for the form:

Official, numbered forms. Swissmedic supplies the forms to the cantons, which pass them on to physicians entitled to prescribe (Art. 47 para. 5 BetmKV). Each form is numbered and carries a barcode, so that pharmacies can check whether it is valid or blocked (Swissmedic notice of 8 November 2017).
Content. The details of the physician and the patient, the date of issue, the medicine, the quantity and the directions for use, with the physician's signature and stamp. A copy is kept in the medical record (Art. 47 para. 1 and 4 BetmKV).
Validity. A narcotics prescription is valid for one month (Art. 47 para. 2 BetmKV); cantonal practice for longer treatment periods varies.
Quantity. At most the need for one month of treatment. Where circumstances justify it, up to three months, with the exact duration of the treatment stated on the prescription (Art. 47 para. 3 BetmKV).
No repeat dispensing. Unless the physician notes otherwise, repeat dispensing is not permitted (Art. 51 para. 3 BetmKV).

More: validity and quantity.

How the prescription reaches the pharmacy

According to position paper 0025 of the Association of Cantonal Pharmacists (KAV), the white original and the pink copy must be physically present at the pharmacy when the medicine is dispensed. Digital transmission is not possible for Verzeichnisse a and d. The original can be handed or posted to the patient or, with the patient's documented consent, posted directly to a pharmacy of the patient's choice. Sending it by e-mail, messenger service or fax is not allowed (KAV 0025).

You choose the pharmacy. A prescription becomes the property of the person for whom it was issued, and that person remains free to choose where to have it filled. Prescribers must not influence that choice if they derive a material benefit from it (Art. 26 para. 2bis let. b and para. 3 HMG). Our practice has no contracts with any pharmacy. We are a practice, not a pharmacy: we do not store, sell or send medicines.

Dispensing, where applicable, takes place only through licensed pharmacies, under the supervision of Swissmedic and the cantons. Pharmacies may dispense narcotics to the public only on a medical prescription (Art. 13 BetmG).

More: how the prescription reaches the pharmacy, choosing a pharmacy, free choice of pharmacy, postal delivery rules and our pharmacies page.

Costs and insurance

Our fees for the consultations are on the prices page. The pharmacy bills any medicine separately.

According to the BAG, the benefits catalogue of compulsory health insurance currently contains no cannabis medicines. Basic insurance therefore reimburses them only in exceptional cases. Reimbursement in an individual case under Art. 71a to 71d KVV requires a prior cost approval (Kostengutsprache), which the insurer gives only after consulting its medical adviser (Vertrauensarzt). According to the BAG, a supplementary insurance may have to pay if the policy provides the cover.

Where medically indicated, our physician prepares the documentation for a cost-approval request. The decision lies with the insurer. Details: health insurance and cost approval.

Reporting to the BAG: MeCanna

The BAG collects data on medical treatments with cannabis medicines, for the scientific evaluation of the law and for statistics (Art. 8b BetmG). Treating physicians record the data in pseudonymised form in the BAG's information system MeCanna (Art. 18f BetmG; Art. 65a to 65f BetmKV). More: reporting to the FOPH.

Travelling abroad

Travellers may take medicines with controlled substances (none from Verzeichnis d) needed for at most 30 days of treatment out of Switzerland without an export permit, if the destination country allows it. For travel to a Schengen state, patients are entitled to a certificate from their treating physician. The pharmacist who dispenses the medicine authenticates it; it is valid for at most 30 days, and one certificate is needed per medicine (Art. 42 BetmKV). According to Swissmedic, the rules of the destination and transit countries apply outside the Schengen area. Details: travelling with prescribed narcotics and the Schengen certificate.

Driving

Anyone who lacks the necessary physical and mental capacity, for example because of narcotics or medicines, is unfit to drive and must not drive (Art. 31 para. 2 SVG). For THC, Swiss law applies zero tolerance: if it is detected in a driver's blood, unfitness to drive is deemed proven (Art. 2 para. 2 let. a VRV). For persons who can prove that they take it according to a medical prescription, detection alone does not prove unfitness (Art. 2 para. 2ter VRV). The general rule still applies: anyone who is actually unfit must not drive. Details: driving with a medical prescription, fitness to drive and the road traffic office.

The canton level

In the cantons, cantonal pharmacists enforce federal and cantonal law on therapeutic products, in particular the Therapeutic Products Act and the Narcotics Act. They supervise pharmacies and the trade in medicines, and they coordinate nationally through the KAV, whose position paper 0025 is cited above (KAV). According to the BAG, cantonal physicians supervise compliance with the medical duty of care. Physicians order their narcotics prescription pads from the cantonal health authority (Swissmedic notice of 8 November 2017).

Our canton pages name the office responsible in each canton, and who supervises prescriptions explains the roles.

How our consultation works

Our consultations are held by our physician Oxana Smagulova, who is licensed in Switzerland. Our practice works entirely online, with two separate appointments:

The free information call. Ten minutes on the process, the legal situation and the costs. It is an information conversation, not medical advice and not a medical appointment.
The medical consultation. A video appointment with our physician. She reviews your medical history and your current medication, answers your questions and documents the assessment. Where medically indicated, she sets out a treatment plan in writing.

Whether treatment is an option is decided individually by the physician during the consultation. There is no entitlement to a prescription; the physician decides on the basis of the medical assessment.

Follow-up consultations take place by video with the same physician. The free patient guide explains the process in writing.

More on the consultation: how the consultation works and preparing for your first consultation. Our city pages describe the video consultation for patients in individual towns, and the glossary explains telemedicine.