News item | 24-01-2023 | 16:16
A growing number of patients depend on new, innovative medicines for their care. It is important that these patients can count on appropriate care now and in the future. It is therefore important that medicines remain available and accessible. New innovative medicines are often very expensive and expenditure on them has been increasing for years. This will become unsustainable in the long term and that is why Minister Ernst Kuipers (Public Health, Welfare and Sport) is having the rules for admitting expensive medicines to the basic package of insured care adjusted as of 1 July 2023. He does this by tightening up the so-called lock criteria.
New medicines are automatically reimbursed from the basic package if they comply with the legal rules. Exceptions to this are the most expensive new medicines. Before patients have access to these medicines, their effectiveness is first assessed and then the price is negotiated with the manufacturer.
Currently, medicines are placed in the lock when annual expenditure in the Netherlands is expected to reach € 40 million or more. As of 1 July, Minister Kuipers will lower this limit to €20 million or more. Another lock criterion remains unchanged. This concerns resources for which the expected costs of dispensing the medicine for the treatment of a new indication are € 50,000 or more per patient per year and the expected total costs of the dispensations amount to € 10 million or more per year.
Once agreement has been reached with the manufacturer on an acceptable price for the new medicine, the medicine is removed from the lock and admitted to the basic package of insured care. Ultimately, this procedure prevents the reimbursement of a new drug from incurring disproportionate costs compared to other drugs. This will prevent the health care premium from rising unnecessarily in the coming years.
Minister Ernst Kuipers: “Adjusting the sluice criteria is an important step in keeping innovative medicines available for patients who benefit from them. At the same time, it is necessary to prevent medicines from becoming more expensive. But just adjusting the sluice criteria is not enough. I will therefore consult with the Zorginstituut and other parties involved to see whether the controlled influx of expensive, innovative medicines can be improved even further.”
In the Integral Care Agreement (IZA) recently concluded with many healthcare parties, it has been agreed that healthcare must remain accessible and affordable. It is important that patients can count on good, accessible and affordable care, now and in the future, and this includes new medicines. The adjustment to the sluice criteria is a next step in the future-proofing of new resources.