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Netherlands

Reimbursement of anti-dementia drugs

The availability of medicines in general

The health insurance system in the Netherlands is a mixture of private and public insurance schemes. In 2006, there as a huge change in the system. Hospital and GP care, drugs and other short term care is now insured by private insurance companies, within the framework of public rules about acceptance, settlement of bad risks and price. Long term care is still part of public insurance.

Only pharmaceutical products with a marketing authorisation are added to a positive list by the health ministry.

Products with a reference price are listed in annex 1a. If a reference price cannot be allocated to a product it will be placed in annex 1b. When deciding about the reimbursement of products in annex 1b the therapeutic value of the product is considered. If the therapeutic value of a product is low it will not be considered eligible for reimbursement. Some drugs in the positive list are classified into annex 2. These drugs are reimbursed only if certain criteria are fulfilled. The criteria could be, for example, that the prescription must be written by a specialist physician. [1]

The availability of Alzheimer treatments

With the exception of donepezil, anti-dementia drugs are available in the Netherlands and are part of the reimbursement system. Since these drugs are on annex 2 of the positive list, certain criteria need to be fulfilled prior to reimbursement. Only specialist doctors can initiate and continue treatment and the reimbursement system provides a clear diagnosis and treatment protocol.

Treatment with acetylcholinesterase inhibitors is for people with MMSE scores between 26 and 10 and memantine for MMSE scores between 14 and 3.

There are no restrictions in the Netherlands for the reimbursement of these treatments for people living alone. Although there are no restrictions in theory for the access of people in nursing homes, the Dutch Alzheimer’s organisation stresses that reimbursement remains problematic, since the cost of treatment would need to be covered by the budgets of the nursing home and may thus be dependent on a positive decision of the home in question.

 

Donepezil

Rivastigmine

Galantamine

Memantine

Reimbursement

No

Yes

Yes

Yes

Initial treatment decision

N/A

Specialist doctors

Specialist doctors

Specialist doctors

Continuing treatment decision

N/A

Specialist doctors

Specialist doctors

Specialist doctors

Required examinations

N/A

Diagnostic protocol

Diagnostic protocol

Diagnostic protocol

MMSE limits

N/A

26-10

26-10

14-3

People living alone

N/A

No restrictions

No restrictions

No restrictions

People in nursing homes

N/A

No restrictions

No restrictions

No restrictions

[1] Martikainen J, Rajaniemi S. Drug reimbursement systems in EU MemberStates, Iceland and Norway. Helsinki: The Social Insurance Institution, Finland, Social security and health reports 54, 2002. 130 pp. ISBN 951-669-612-0.

 

 
 

Last Updated: mercredi 15 juillet 2009

 

 
 

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