Is the drug that I want to prescribe reimbursed?

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How can I find out if the drug that I want to prescribe to my patient is reimbursed by the national health insurance program?

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Hi,

I can try to answer for the Netherlands, as reimbursement is a national issue.

In NL, it depends where you can find that information.

For outpatient (extramuraal) drugs (generally oral and subcutan), these drugs are in or out of the Geneesmiddelenvergoedingssyteem (GVS).
The easiest way to know is to go to www.medicijnkosten.nl, enter the drug and if it says ā€˜Dit middel wordt volledig vergoed door uw zorgverzekeraar.ā€™ it is reimbursed.
If it doesnā€™t say that and you want to know details, go to this government website and look up the drug (try both on brand name or active substance) and in which appendix (ā€œBijlageā€) it is.
1A: It is deemed interchangeable with other drugs and the reimbursement limit (=maximum a health insurer is allowed to reimburse) is the average of the drugs in the so-called ā€˜clusterā€™. If the price of a single drug is higher, a patient has to pay the difference out-of-pocket.
1B: Is it reimbursed without a reimbursement limit.
2: If a drug is also on Bijlage 2, there are additional conditions for reimbursement (for example restrictions in patient population/ line of treatment).
3: The authorised drug is not reimbursed, but the pharmacy preparation is.

For inpatient drugs (generally the other methods of administration + all oncology products), these drugs must be paid by the hospital. But the hospital can ask for special coverage for expensive drugs by requesting an add-on.
For inpatients drugs, www.medicijnkosten.nl will tell you it is reimbursed but that there is an add-on with conditions. In a lot of cases, this add-on covers the authorized indication (and maybe also off-label indications), but sometimes the add-on limits reimbursement to for example a sub population or it has additional conditions such as an indication committee. The list with the reimbursement status and exact conditions is unfortunately not available for free (G-Standaard).

Hope this makes senseā€¦

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