What medicines are covered by insurance?
The standard package covers most medicines prescribed by your general practitioner or consultant. In some cases you may have to pay part of the cost yourself. Or your insurer may only provide full cover for the cheapest version of a drug. The cost of medicines that are covered by your insurance policy is first deducted from your excess.
Cover for registered drugs
Health insurers only provide cover for registered drugs that are included in the Medicines Reimbursement System.
Cover for non-registered drugs
Health insurers normally do not provide cover for medicines that are not registered, except in the following exceptional circumstances:
- the non-registered drug is a last resort, as no further treatment options are available for your condition in the Netherlands;
- you have a very rare disease that affects no more than 1 in 150,000 people in the Netherlands;
- no equivalent medicine is registered for treating your condition.
Cover for branded drugs
Most health insurers only provide cover for the cheapest version of a medicine. It contains the same active ingredient or is essentially the same as the branded drug. Your insurer may agree to reimburse the more expensive medicine if your doctor has prescribed it for a medical reason. For instance, you may be allergic to certain ingredients in the cheaper drug. In that case, the doctor must write ‘medically necessary’ on the prescription.
Finding information about cover for medication
You can find information about cover for medication on Medicijnkosten.nl (in Dutch). This website tells you:
- whether the medicine is covered by the standard health insurance package;
- what part of the cost will be deducted from your excess;
- whether you have to pay part of the cost;
- if a cheaper alternative is available for which your insurer provides full cover.
Co-payment for medicines
There are various reasons why your insurer may require you to pay part of the cost for a drug. Medicines are grouped into categories. Drugs in the same category are essentially equivalent, but their prices may differ. The standard package sets a maximum price for every category of drug. If you buy a medicine that costs more than the maximum price, you will have to pay the difference. You can take out additional insurance to cover these costs.
Co-payment for Concerta and Strattera
The drugs Concerta and Strattera are frequently used to treat ADHD. A co-payment is required for these drugs. This is because they fall under the same category as methylphenidate (Ritalin), which is cheaper. There are no major differences between Concerta, Strattera and Ritalin, so full cover is only provided for Ritalin, since it is the cheaper drug.