Keeping medicines affordable

Without government measures, the costs of pharmaceutical drugs would rise by at least 10% every year. The government makes agreements with doctors, pharmacists and health insurers to control these costs.

Measures by the third Rutte government

The Minister for Medical Care and Sport has proposed various measures to control the cost of medicines:

  • amending the Medicine Prices Act;
  • modernising the Medicines Reimbursement System;
  • limiting co-payment for medicines to €250 per patient;
  • stepping up negotiations between pharmaceutical companies and the Ministry of Health, Welfare and Sport;
  • providing more clarity about when pharmacists can make medicines themselves.

These measures will ultimately result in savings  of €467 million per year as of 2022.

Amending the Medicine Prices Act

The Dutch Medicine Prices Act sets maximum allowable prices for medicines (in Dutch) based on the average of what similar medicines cost in 4 reference countries: currently Belgium, France, Germany and the United Kingdom. However, many medicines are far more expensive in Germany and this pushes up the maximum allowable price in the Netherlands. The minister is therefore going to amend the Act and replace Germany with Norway as a reference country. This will lead to lower prices in the Netherlands.

The amendment should result in a saving of €160 million on medicines dispensed by pharmacies outside hospitals. Savings will also be made on medicines dispensed in hospitals.

Modernising the Medicines Reimbursement System

Health insurers only reimburse registered prescription drugs that are included in the Medicines Reimbursement System (GVS). There are around 500 groups (‘clusters’) of drugs in the GVS. The medicines in each cluster can be substituted for one another. A maximum reimbursement has been set for each cluster in the GVS. If a patient uses a medicine that costs more than this amount, they have to pay the difference.

The Ministry of Health, Welfare and Sport is going to review the reimbursement ceiling for each drug cluster. In some cases, the amount that is reimbursed may be too low, resulting in high co-payments for patients. For other clusters, there may be a large number of competitively priced drugs available on the market, so that the amount reimbursed can be reduced.

Modernisation of the GVS should make the system fit for the future and result in permanent cost savings of €140 million as of 2022.

Maximum co-payment of €250 per patient

The co-payment for medicines that cost more than the reimbursement ceiling comes on top of patients’ compulsory excess of €385 per year. The government has decided to limit these co-payments to €250 per patient per year as of 2019. Health insurers must reimburse the remaining amount.

Other measures

The government also wants to ensure more competitive prices are negotiated with pharmaceutical companies. The Minister for Medical Care will take the lead in more of these negotiations. Health insurers will not reimburse a medicine until these negotiations are concluded. Negotiating more competitive prices could result in annual savings of €155 million. In 2017, the total savings were €132 million. The government also wants to give pharmacists more clarity about when they can make medicines themselves.

Including new medicines in the standard health insurance package

Health insurers are not automatically allowed to provide cover for any new medicine that comes onto the market. The Ministry of Health, Welfare and Sport and the Healthcare Institute of the Netherlands decide what drugs fall under the standard health insurance package. Registered medicines have to be assessed before they can be included in the Medicines Reimbursement System (GVS). Medicines listed in the GVS are fully or partially reimbursed by health insurers.

Expensive medicines are not automatically covered

The standard health insurance package does not automatically cover new, expensive medicines. The minister can decide to temporarily exclude new drugs from the standard package. These medicines are then put ‘on hold’. The Healthcare Institute of the Netherlands can then issue an advisory opinion on their use and the minister can negotiate a better price with the manufacturer. A medicine is put on hold if

  • using the medicine for one or more new indications would cost more than €40 million per year across the Netherlands;
  • using the medicine for one new indication would cost more than €50,000 per patient per year, and more than €10 million per year across the Netherlands.

It is only the medicine itself that is put on hold; all other parts of the patient’s treatment, including hospital admission, are still covered by health insurance. 

Reducing the cost of expensive medicines

The Minister of Health, Welfare and Sport (VWS) wants to know why some medicines are so expensive. People have the right to know what their health insurance premiums are being spent on.

Austria, Belgium, Ireland, Luxembourg and the Netherlands have joined forces in the Beneluxa Initiative to give patients access to innovative medicines faster and at an affordable price. For more information about this collaboration between 5 European countries, go to the Beneluxa Initiative website.

Procurement of expensive medicines

Expensive medicines need to become more affordable and more accessible. The government has set up the Platform for the Procurement of Expensive Drugs (Platform Inkoopkracht Dure Geneesmiddelen) in order to improve procurement of these medicines by hospitals. The Platform brings together experts in this field from hospitals, pharmacies, health insurers and universities.

Health insurers provide cover for the cheapest version of a medicine

Most health insurers usually only provide cover for the cheapest version of a medicine containing the same active ingredient as the branded drug. This is referred to as preferential policy. By using cheaper versions of the same medicine:

  • health insurers spend less money on medication
  • so that they can keep premiums low
  • and patients pay the lowest price for the medicine if it falls under their excess.