Our ambitions for Dutch patients
Every year, new medicines become available to patients. We are also helping more and more patients. But Dutch patients do not always have access and have to wait longer and longer.
Medicine companies work hard to develop new treatments. Every year, new medicines come to market that can make a world of difference.
Before a medicine can be marketed, approval must first be obtained from the European Medicines Agency (EMA) in Amsterdam. The EMA assesses new drugs for quality, effectiveness and safety. Medicines that do not meet these criteria are not admitted to the market.
The fact that hospital drug expenditures are increasing is primarily due to a growth in the number of patients. The number of patients taking hospital drugs, increased 14% per year between 2015 and 2020.
For medicines that the government expects to have a relatively high price and or budget impact, the so-called lock-procedure applies.
Each year, about fifteen new, innovative medicines are kept out of the insurance package and placed in the lock by the minister. The time required to complete the lock procedure increases each year.
The processing times are largely due to price negotiations between the minister and drug companies. But delays in the submission of reimbursement files and in the assessment process also contribute.
Reimbursement by the insurer does not automatically mean that a new medicine will also be prescribed in practice. Twelve months after inclusion in the insurance package, the actual use of 13 innovative cancer medicines in the Netherlands is the lowest of all 10 countries participating in the study.
A possible cause for the low use of new cancer medicines in the Netherlands, may be the decentralized price negotiations with hospitals, the researchers argue. After inclusion in the insurance package, insurers and hospitals must agree on payment. This means that each hospital in the Netherlands enters into an individual contract with the pharmaceutical company. This leads to large differences in the availability of medicines in hospitals, even when a medicine is reimbursed.
The healthcare expenditures that count toward the Healthcare Budget Framework consist of the Health Insurance Act, the Long-Term Care Act, and other expenditures.
Costs for medicines are covered by the Health Insurance Act. A distinction is made here between medicines that are dispensed inside and outside hospitals. The medicines dispensed within hospitals are intramural medicines. This group falls under the category of specialist medical care. Medicines dispensed outside hospitals are extramural. These group falls into the pharmaceutical care category. The expenditure of both types of drugs in 2020 amounted to € 6.6 billion.
The expenses in this overview are based on the invoiced prices. In practice, the costs of specialist medicines are lower than the list prices. This is because insurers, hospitals, pharmacies and sometimes the government itself negotiate the price of a medicine with the manufacturer. The outcome of these negotiations is only partially public.
Over the past decade, total government spending on healthcare increased from €56 to €79.1 billion. Expenditure on medicines increased to €6.6 billion, this is excluding pharmacy fees. The share of medicines in the care budget decreased from 8.9 to 8.3% during this period.
Consumer prices have increased over the past 20 years. Prices of housing and transportation, for example, rose an average of 2% per year. The prices of drugs increased 0.5% annually over the same twenty years.
Total drug expenditures increased slightly more than this percentage as overall drug use increases.
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