“We intend to take a more critical look at the social acceptability of the price of medicines before they are included in the package,” says Minister Jan Anthonie Bruijn of VWS.
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Rising expenditure on expensive medicines has been a cause of concern for some time. This puts pressure on other healthcare, because the idea is that when you spend more money on expensive medicines, you can spend less on hospital care, for example.
In 2021, in the Kuiken motion, the House of Representatives asked the Healthcare Institute and regulators NZa and ACM to investigate how the prices of medicines can remain socially acceptable. The Socially Acceptable Expenditure on Medicines (MAUG) program was set up for this purpose in 2023. After more than two years, the parties presented their advice to the minister on Wednesday afternoon.
But what is actually a socially acceptable price? This question was submitted by the Radboud university medical center to a citizens’ platform. This showed that the Dutch do not simply want to include all medicines in the package.
“If the price is too high, we must clearly say no,” is one of the conclusions from the citizens’ platform. And ‘the assessment framework for which medicines may and may not be included in the package must be tightened’ was another.
Questionable operation
With this input, the parties in the MAUG program continued to work. They have formulated a number of principles. For example, a medicine may cost more if it provides better health or if it is used for serious diseases. But if the effect of a medicine is questionable if it is not very innovative, the price may be lower.
If the medicine has many potential users, causing society to spend a lot on the drug, the price must be lowered.
Many of these principles are already used by the Healthcare Institute when assessing a new medicine. But they will have a greater influence, explains Mark Janssen of the Healthcare Institute.
“We are now looking very closely at what a drug can do for the patient. What health benefits are achieved. But with this we also look at what the impact is for society.”
High price only temporarily
Another important point that is receiving more attention is competition. A high price should be temporary, the parties believe. If a new medicine is just included in the basic package, the price may be higher than some time later, when it is likely that the manufacturer of the medicine has recouped its investment.
“In the current system, the price of a drug often remains high for an unnecessarily long time,” says Geranne Engwirda, chairman of the NZa.
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After a patent expires, competing parties can enter the market, causing the price of a drug to drop. But pharmaceutical companies use all kinds of tricks, which are not prohibited, to extend those patents.
“Then, for example, they bring a new dosage form of the same medicine onto the market and they can charge a high price for it. But we are now going to look more critically at whether we as a society still want to pay that higher price,” says Engwirda.
Worldwide unrest
The report comes at a critical time. There is a lot of unrest worldwide about drug prices. For example, President Trump has demanded from the United States that pharmaceutical companies lower their prices in that country. Trump thinks it is unfair that the US pays much more for medicines and states that European countries should contribute more.
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Pharmaceutical companies also call the Netherlands extra strict. And they point out the possible consequences for patients. If the Netherlands becomes even stricter in its admission policy for innovative medicines, pharmaceutical companies may withdraw from our country, the pharmaceutical industry association has said on several occasions.
“As long as they can still generate billions of euros in turnover here, I don’t see them leaving so quickly,” says Janssen of the Healthcare Institute. Minister Bruin says that in that context it is also important to make agreements at European level.