The availability of medicines in general

In Belgium, the reimbursement system has classified drugs into different reimbursement categories.

• Medicines in category A for serious illnesses are fully covered by the system and free of charge for the patient.
• For medicines in category B (useful drugs), the patient is required to pay 25% up to a ceiling of € 10.20.
• For medicines in category C (less useful drugs), the patient is required to pay 50% up to a ceiling of € 17.00. This percentage may go up to 60% or 80% for drugs certain medicines in this group which fall under category CS (ease drugs) or Cx (for example: contraceptives).

For medicines for which an identical generic product exists, the refund by the reimbursement system is reduced by 30%.[1]

The availability of Alzheimer treatments

All four anti-dementia drugs are available to patients in Belgium and are part of the reimbursement system.

Belgium has a very strict treatment protocol for drugs to be reimbursed. Amongst others, it limits the prescription of anti-dementia drugs to specialist doctors, both for treatment initiation and for treatment continuation. An MMSE score of between 24-12 is required for the reimbursement of acetylcholinesterase inhibitors and a score of between 15 and 3 for the reimbursement of memantine.

The Belgian system explicitly limits reimbursement to one class of drugs only, so that patients would not be able to receive bi-therapy under the system unlike some other European countries. According to the Ligue Alzheimer, a significant number of patients and carers have to pay for their Alzheimer medicines, because their general practitioners failed to refer them to a specialist.

The reimbursement system does not impose any restrictions for the reimbursement of people living alone or in nursing homes.

[1] European Commission (2006): MISSOC – Mutual information system on social protection : Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland : Comparative tables