In this update, we describe a number of recent developments relating to pricing and reimbursement in the Netherlands, including the announcement of a new measure of temporarily excluding a new expensive medicinal product from reimbursement and the publication of two important reports regarding access to expensive medicinal products and sustainability of the reimbursement system. The reports were prepared on the instruction of the Dutch Minister of Health (MoH). Both reports describe and analyze the current and future problems regarding the access to and financing of expensive medicinal products and suggest solutions to solve such problems. The MoH has announced to present her vision for the future of pricing and reimbursement in Fall 2015.

  1. Temporary exclusion of new medicinal product

 The MoH informed in July that she will apply a new measure to ensure better cost containment of a new medicinal product for the treatment of lung cancer. Considering the potential high cost impact for this indication the MoH informed that this product will (for this indication) be placed in so-called 'lock'. This lock will in fact be a statutory list which contains forms of care that are excluded from the insured package. After positive assessment by the competent reimbursement authorities and successful price negotiations between the pharmaceutical company and the MoH, the product will be removed from the 'lock' and will as of then form part of the insured package. This is the latest measure of the MoH in a series of measures to try and ensure better cost containment of expensive medicinal products for use in the hospital which normally form part of the insured care in the hospital as of the moment such product is authorised and prescribed. It is expected that this measure will also be used for other new expensive medicinal products.

 

  1. Reports of the Dutch Healthcare Authority and the Dutch Cancer Society on access and sustainability of medicinal products in specialist medical care

Both the Dutch Healthcare Authority (NZa) and a working group established by the Dutch Cancer Society (KWF) have been asked by the MoH to prepare a report on the current and future issues regarding the financing of and access to expensive medicinal products. The Dutch Healthcare Authority focused on medicinal products that are used as part of specialist medical care. The working group established by the Dutch Cancer Society focused on expensive oncology medicinal products. The conclusions and suggested solutions of both reports follow the same lines: access to expensive medicinal products is not and cannot be guaranteed sufficiently for patients as a result of financial hurdles. Patients are not always treated according to professional treatment guidelines as a result of such hurdles and it appears that treatment of patients may vary between hospitals and regions. Both reports suggest various solutions of how to approach and solve these problems in order to ensure effective and equal access for all Dutch insured patients in a financially sound system. Considering that the MoH has instructed such reports to be prepared and published and considering the series of measures and pilots that the MoH has taken over the last years it may be expected that these reports will lead to more changes. The solutions and recommendations as outlined in both reports focus on stricter entitlement, lower prices and more efficient prescription behavior. We discuss some of the suggested solutions and recommendations below.

  • Introduce a more strict system for reimbursement of expensive medicinal products in the hospital, by i.e. introducing an assessment procedure for such products 'at the gate', remove products from the insured package if such products do not comply with reimbursement conditions.
  • Stimulate and ensure better and appropriate prescription behavior of physicians by i.e. introducing disease related registries, developing professional prescription guidelines for certain (new) medicinal products, anticipation on new medicinal products in professional treatment guidelines, creating the situation in which the mere possibility of prescribing an expensive medicinal product does not automatically lead to such prescription but is based on an informed decision and discussion between the physician and the patient.
  • Introduce measures to lower prices of medicinal products by i.e. requiring more transparency from the pharmaceutical industry on how a price is calculated, set maximum prices for all medicinal products authorised in the Netherlands, combine purchase power by combining various hospitals, act together with other European governments in price negotiations.
  • Consider additional and earmarked budgets for expensive specialist medicinal products used in hospitals and create more flexibility in the contracts between healthcare professionals and health insurance companies to be able and adjust contracts on an ongoing basis in respect of expensive medicinal products.

In a joint letter to the MoH, the association of health insurance companies and the associations of hospitals and of university hospitals identified problems for funding expensive medicinal products and concluded that the current system was not sustainable. They also suggested to only reimburse expensive medicinal products after a prior political decision is taken, rather than including new products in the health insurance coverage automatically.